Wednesday, June 2, 2004

Washington Times special correspondent John Zarocostas in Geneva recently interviewed the health minister of Uganda, a country on the front lines of worldwide efforts to halt the spread of HIV, the virus that causes AIDS. In 2003, Africa accounted for two-thirds of the world’s people with HIV/AIDS.

Question: Brig. Jim K. Muhwezi, as health minister of Uganda, how has your country managed to stem the spread of AIDS with limited resources?

Answer: We have managed because we used approaches that did not require money and mobilized the population to prevent HIV infection. The major factor was the high level of political commitment of the leadership in Uganda — especially his excellency, President Yoweri Kaguta Museveni, who as early as 1986-87 declared that there was HIV/AIDS when no one in the world wanted to admit it.

He said it was a problem, and this problem could not be solved — there was no cure — so everybody had to protect himself and herself.

This trickled down to all leaders. Political leaders, religious leaders, traditional leaders. Everyone — at any opportunity available — was talking about what the president was saying; that there is a disease … and this disease has no cure, and the best way to avoid it was to do the following. And this caught like wildfire.

Q: From a practical point of view, what policies did you follow to get this message out on a mass scale? Did you use the education system and the media, and was there encouragement to use contraceptives?

A: Yes, we used all methods. First of all, we enacted a law establishing the Uganda AIDS Commission. The idea was to bring everybody on board. It was a coordinating body of all sectors, because HIV/AIDS was not only a health matter, but was an economic, educational, agricultural issue — Uganda being an agricultural country.

So this was the coordinating body. We had the law. Then we used media. A lot of media information, education and communication, as we call it. We used papers, radio and so on.

Q: What about contraceptives?

A: Yes, we used contraceptives. What we said, the first line of defense was abstinence for those who hadn’t married yet. Then for those who were already married and sexually active, we said be faithful to your partners. And then for those who couldn’t [be faithful], use condoms — which later came to be known as ABC: abstinence, behavioral change and condoms. And sometimes people add D for dead.

Q: At what point did you stem the increase in infections? How many years did it take?

A: Well, it was gradual, of course. In 1992, in many centers, the prevalence [of AIDS in the population] was as high as 32 percent, but it continued to go down, and by the year 2000 we had brought it down to 6 percent.

Q: How many people are HIV-positive, and how many do you have on anti-retroviral treatment?

A: We have about 1 million who are positive, and we have about 100,000 who need treatment.

Q: How many are receiving anti-retroviral treatment?

A: Not more than 10,000.

Q: Is that because of shortage of funds?

A: Absolutely. It’s because we can’t afford it.

Q: What about these new global programs, and the 2003 initiative by President Bush, and the one announced recently by Tommy Thompson, the U.S. secretary of health and human services, to make more resources available and improve access to cheaper and high-quality drugs?

A: This is good news, of course. It’s coming at the right time. We are happy that President Bush initiated this fund. We are happy with the visit of Secretary Thompson when he visited Uganda. We are happy with the CDC (Centers for Disease Control and Prevention), which is already treating some of our people in Uganda.

When Secretary Thompson came to Uganda, he saw the great job CDC was doing. And also with the Global Fund and these other bilateral and multilateral initiatives.

Q: How many people do you plan to put on anti-retroviral treatment, and what price range do you think you will get the drugs for, or do you anticipate some to be granted without fee?

A: We expect all the people who are sick to be put on treatment.

Q: By when?

A: Within four months.

Q: You expect the other 90,000 to also be on treatment then?

A: Yes, because we have already procured some ARVs (anti-retroviral drugs) using the World Bank money.

Q: How much did the bank grant you?

A: Altogether, we have $50 million from the World Bank, but it’s coming in tranches.

Q: And how much will you be receiving from the United States and President Bush’s fund?

A: I don’t have a fixed figure, but we have already started receiving the money as well.

Q: Will it is in the tens of millions?

A: Yes, and Secretary Thompson told us they are even willing to buy generic drugs, provided they meet the American standards.

Q: The generics that you’re referring to, is the source mainly India?

A: Yes, most of them are from India.

Q: And what is the average price for a year of treatment?

A: Now, less than $25 per month, but it’s come down. It used to be $1,000 per month.

Q: Given our experience in dealing with an epidemic that many countries are struggling with, what would be your message to other health ministers?

A: My message, first of all, is that it can be done … so long as you realize a high-level political commitment to mobilize the population. Then again, carrying out programs in collaboration with partners, like the Global Fund, the United States, because we have a lot of research going on in collaboration with American universities.

It is to have programs in place, to have structures in place, to have political commitment, to collaborate with partners who are willing to support, then we can treat this pandemic.

Q: What are you doing to build the capacity of your health sector?

A: We are training people who are going to be involved in the treatment, because there is a fear if it is not properly done, then we can develop another problem of resistance.

So we are training the people who will be certified to give the treatment. We are establishing voluntary counseling and testing health centers all over the country, and we make it known that only these places can give treatment and can monitor the viral loads.

Q: How many of these centers do you need?

A: Well, we need as many as 2,000.

Q: And what would this cost, and over how many years?

A: It costs a lot of money. I don’t have the figures. It costs money, but it’s important.

Q: You have a military background. How important are logistics in the fight against HIV/AIDS to get everything to run smoothly?

A: It is very important. As you know, we have problems of transport and communications, so that’s why we need the centers closer to the people. Because these are sick people who cannot afford to travel long distances, who cannot walk long distances. That’s why we need to concentrate on capacity-building and good systems of transportation.

Q: Will the very poor be getting some treatment free?

A: We are going to start now with the very poor — the vulnerable children, the orphans, are going to get free treatment. But as I said, with the money now available, we can give free treatment to everybody. We need four months.

Q: This is from the funds from the United States, the World Bank and other bilateral and multilateral donors?

A: Yes, and treatment will be free.

Q: Are there people who are paying for treatment?

A: Many people now are paying for the treatment, coming even from surrounding countries to Uganda to buy, but it’s very expensive.

Q: But is the objective to have free treatment?

A: The objective is to have free treatment, and that is the right thing to do. Because people are poor, and once a person is on this treatment, he must remain on the treatment. If he stops, he dies.

If someone starts on the treatment, and then after two years can’t afford it, it is really criminal to let him die, so we have to give him free treatment.

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