Doreen Kibuka-Musoke explores how Uganda coped with the millions of families hit by HIV-AIDS

Twenty years after the first clinical evidence of Acquired Immune Deficiency Syndrome (AIDS) was reported, it has become one of the most devastating diseases humankind has ever faced. The Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organisation (WHO) estimate that over 60 million people have been infected with the virus since the epidemic began. Worldwide, HIV/AIDS is reported to be the fourth major cause of mortality. The majority of new infections occur among young adults living in the developing world, most of whom do not know that they are infected. About one third of the HIV infected are aged between 15-24 years.

HIV marks a severe development crisis in Sub-Saharan Africa, which remains by far the worst affected region in the world. It is reported that the estimated total number of people living with HIV/AIDS in Sub-Saharan Africa is now 28.1 million. Furthermore, by the end of 1999 the region had 12.1 million orphaned children from AIDS related deaths.

It is hard to underestimate the impact of the AIDS pandemic to development. Badly affected countries are losing highly trained expertise, which is difficult to replace, and often the disease is spreading against a setting of deteriorating public services, poor employment prospects and endemic poverty. Even if effective prevention and treatment and care programmes take hold immediately, the scale of the crisis means that the human and socioeconomic toll will remain significant for many generations.

Nevertheless, there are some signs of hope. Perhaps the most important of all being the case of Uganda, one of the countries in which AIDS was first diagnosed.

Uganda's AIDS crisis

The first cases of clinical AIDS in Uganda were diagnosed in 1982 in Rakai district in the south west of the country. At that time the disease was locally called "slim". It is estimated that today 1.1 million people living in Uganda have HIV/AIDS, with nearly 80% between the ages of 15 to 45 years (UAC, 2002). It has become the leading cause of death for adults, and it is possible that the population of Uganda will plunge from 30 to 20 million by the year 2010 as a result of the epidemic.

Uganda records the highest proportion of AIDS orphans in the world. Many have been forced to drop out of school to start earning money or because their caretakers cannot afford school fees. Furthermore, a recent UNAIDS report estimated that 110,000 children were living with HIV/AIDS in Uganda at the end of 2001. This high number is evidence that mother to children transmission is a challenge. The demographic structure in Uganda is undergoing considerable transformation. Families commonly comprise of a grandparent surrounded by grandchildren. There are also large numbers of children-headed families and communities of children without any caring adults at all.

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