A Panoply of Politics: From Treatment Access to Rights-based Prevention in Uganda

1. A Panoply of Politics: From Treatment Access to Rights-based Prevention in Uganda XIX IAC – AIDS 2012 : IAS PRE-CONFERENCE Prof. Edward K. Kirumira College of Humanities & Social Sciences, Makerere University

2. Competing Philosophies • Programmatic, political and cultural exigencies • Experimented with varied combinations of the ABC strategies • The 3-in-One: Prevention, treatment and Care & Support Clocking marked decline and now resurgence of new infections

3. Prevalence Performance • 1987 was at 24%; • peaked in 1990 at 30.81% • started steadily dropping from 29.42% in 1992 to an average of 6.4% in 2006/2007 • down to an arguable 4.5 per cent in urban areas • current sero-behavioural studies indicate prevalence on the rise with a ‘reported’ national average of 7.6 per cent (UAC, 2012)

4. A Panoply of Politics • The rural constituency • The urban and security services consideration • Balancing self-coordinating entities and strong lobbies • Contestation between government and funding streams - the donor question

5. The Rural Constituency • 1980s and early 1990s, infections and prevalence mainly rural • New NRM/A regime riding on mass (mainly rural) support • Minimal essentially government resources • Empathy with the rural populations, that were its major constituency, as politically correct

6. Urban and Security Services Consideration • Shifting infections pattern to the urban areas and the more politically and productively active population • The security services especially the military • Protection and treatment access becomes a political (regime survival) question • Emergence of a strong lobby of people-living-with-AIDS that demanded access to treatment

7. Politics of access to treatment • 1987 with the establishment of the AIDS Control Program in the Ministry of Defence • Establishment of the Joint Clinical Research Centre (JCRC) • 1998 establishment of the Drug Access Initiative to advocate for reduced prices for Anti Retroviral (ARV) drugs

8. Equity and health systems inadequacies – Moving to the Rights • Re-construction of the debate about the relationship between ART universal coverage policy and prevention strategies • Increased concern over and for marginalised groups (MARPs) • Serious contestation between major funding streams and government • Reminded of and guided by and aligned to agreed national priorities (UAC, 2010)

9. Politics of the New National Strategic Plan • Almost a full turn around to prevention or treatment for prevention/protection • Rights-based approach with minority populations - though broadly defined - as a catch word • From products to rights • Unexpected actors like the Inter-Religious Council for Uganda (IRCU) addressing issues of MSM

10. A panoply of politics? • Unlocking or rekindling the political will within a globalized epidemic • Multilateral governance (e.g. the Central Coordinating Mechanism for Global Fund; the Partnership Committee) • Re-engineering/interrogating coalitions – government and civil society, 3-in-one philosophy, etc..

11. Politics in must be! • We aim for responsive panoply of politics as we move or seek to move from treatment access to a rights-based prevention strategic framework. THANK YOU