In 2018, an estimated 1.4 million people were living with HIV, and an estimated 23,000 Ugandans died of AIDS-related illnesses.
The epidemic is firmly established in the general population. As of 2018, the estimated HIV prevalence among adults (aged 15 to 49) stood at 5.7%. Women are disproportionately affected, with 8.8% of adult women living with HIV compared to 4.3% of men.
Other groups particularly affected by HIV in Uganda are sex workers, young girls and adolescent women, men who have sex with men, people who inject drugs and people from Uganda’s transient fishing communities.
There has been a gradual increase in the number of people living with HIV accessing treatment. In 2013, Uganda reached a tipping point whereby the number of new infections per year was less than the number of people beginning to receive antiretroviral treatment.
However, as of 2018 around 27% of adults living with HIV and 33% of children living with HIV were still not on treatment. Persistent disparities remain around who is accessing treatment and many people living with HIV experience stigma and discrimination.
Uganda 90-90-90 progress (2018) graphic
Groups most affected by HIV in Uganda
Adolescent girls and young women
HIV prevalence is almost four times higher among young women aged 15 to 24 than young men of the same age.
The issues faced by this demographic include gender-based violence (including sexual abuse) and a lack of access to education, health services, social protection and information about how they cope with these inequities and injustices. Indeed, young Ugandan women who have experienced intimate partner violence are 50% more likely to have acquired HIV than women who had not experienced violence.
The lack of sexual education is telling. In 2014, only 38.5% of young women and men aged 15-24 could correctly identify ways of preventing the sexual transmission of HIV and rejected major misconceptions about HIV transmission.
Sex workers
HIV prevalence among sex workers was estimated at 37% in 2015/16.
It is estimated that sex workers and their clients accounted for 18% of new HIV infections in Uganda in 2015/16.
A 2015 evidence review found between 33% and 55% of sex workers in Uganda reported inconsistent condom use in the past month, driven by the fact that clients will often pay more for sex without a condom.
…you could be in a bad situation yet you are sick and on medication. At the same time you may not have anything to eat… you look for a man who can help you. Then that man will give you conditions… if you are going to have sex with him with a condom he will give you Uganda Shillings (UGX) 2,000/ =, then he says that if it is without a condom he will give you 20,000/=. Because you can't help yourself, there is no way you can leave UGX 20,000/= and go for UGX 2,000/=
- Female sex worker, Malaba.
Violence is common, with more than 80% of sex workers experiencing recent client-perpetrated violence and 18% experiencing intimate partner violence. More than 30% had a history of extreme war-related trauma.
The criminalisation of sex work and entrenched social stigma means sex workers often avoid accessing health services and conceal their occupation from healthcare providers. In particular, stigma towards male sex workers who have sex with men is exacerbated by homophobia. Indeed, many sex workers in Uganda consider social discrimination as a major barrier in their willingness or desire to test for HIV.
Men who have sex with men (MSM)
HIV prevalence among men who have sex with men (sometimes referred to as MSM) in Uganda was an estimated 13% in 2013, the most recent data available.
A 2017 study among men who have sex with men in Kampala reported high risk behaviours to be common, including 36% of respondents reporting regularl unprotected anal sex, 38% selling sex, 54% having multiple steady partners, 64% having multiple casual partners, and 32% injecting drugs.
Pervasive HIV-related social stigma and high levels of homophobic violence caused by conservative social attitudes and stigmatising legislation result in men who have sex with men feeling less inclined to access HIV services. The 2017 study mentioned above found 40% had experienced homophobic abuse and 44.5% had experienced suicidal thoughts.
The Uganda Anti-Homosexuality Act was passed by parliament in December 2013 and officially signed into law in February 2014. Although the law was annulled in August 2014 due to a technicality based on the number of MPs present during the vote, it is thought to have resulted in increased harassment and prosecution based on sexual orientation and gender identities. It has also triggered negative discussions from the general population on social media, in which violence and anti-homosexual discrimination are advocated.
HIV outreach workers and services providers working in Uganda with men who have sex with men have also reported heightened challenges in reaching this population.
People who inject drugs (PWID)
In sub-Saharan Africa, people who inject drugs (sometimes referred to as PWID) are highly stigmatised and open to severe discrimination. In many cases this marginalisation can be felt on a governmental level, leaving this group with very little in the way of adequate HIV and health services.
Since the Global State of Harm report in 2014 estimated HIV prevalence among people who inject drugs at 16.7% in Uganda, the government has pledged to prioritise innovative approaches to help this population.22 In 2017, the Ugandan Ministry of Health authorised a number of needle and syringe programmes to be piloted.
Fishing communities
HIV prevalence among Uganda’s fishing communities is estimated to be three times higher than the general population. A 2013 study of 46 fishing communities found HIV prevalence to be at 22% with no variation between men and women.
The reason for such high prevalence among this community is thought to be the result of a complex range of factors including a high degree of mobility, a high rate of fisherman who pay for sex, injecting drugs use, and a lack of access to HIV prevention and testing services.
HIV testing and counselling (HTC) in Uganda
Increasing knowledge of HIV status through HIV testing and counselling (HTC) is a key route to tackle Uganda’s HIV epidemic. HTC services have been expanded and the number of people testing for HIV is increasing as a result, from 5.1 million in 2012 to 10.3 million in 2015.
Testing is conducted in health facilities, in community settings and in people’s homes. In recent years there has been more emphasis to promote HTC services for couples, workplaces testing, outreach to most at risk groups, and mobile or mass testing, especially during testing campaigns. In 2017, the Ministry of Health piloted oral HIV self-testing kits among fishermen, female sex workers and the male partners of women attending antenatal care.
The proportion of women (ages 15-49) who have tested for HIV and received their results in the past 12 months increased from 47.7% in 2012 to 57.1% in 2014 and from 37.4% to 45.6% among men.
As a result of this discrepancy, only 55% of men and boys living with HIV know their status, compared to 82% of women and girls. Some men report they would rather avoid knowing their HIV status because they associate being HIV-positive with ‘emasculating’ stigma.
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