AIDS in Uganda — Clinical and Social Features

This article highlights the clinical and social features of the AIDS epidemic in Uganda. AIDS is already the most common cause of admission and death among hospitalized adults in many parts of the country. 1 million adults out of a country of 17 million people are estimated to be HIV-seropositive. With such a large population of HIV infected people high risks no longer exist and knowing a patient's social history rarely helps in diagnosing AIDS. Tuberculosis is now ubiquitous with a doubling in the number of cases from 1984 to 1987. With few reliable laboratory resources, a patient with AIDS with a pulmonary infiltrate can present a dilemma to a Ugandan health worker. Even though HIV testing is not routinely available in Uganda where resources are being used to repair a damaged economy, the clinical criteria for diagnosing AIDS may actually be more than 92% specific. A benefit to the clinical diagnosis is that many treatable non-HIV-related illnesses, such as diabetes, are frequently undiagnosed as AIDS related syndrome in people who are shown to be HIV seropositive by routine testing. Since AIDS immunosuppresses patients, the local opportunistic infections indicate the common environmental pathogens. In Uganda the highly prevalent infections are: syphilis, 5-30%; cytomegalovirus infection, 100%; toxoplasmosis, 50-75%; and chronic hepatitis B antigenemia, 15%. Unfortunately, there is little a Ugandan physician can do for AIDS patients with limited health resources. Counseling is controversial due to expected social norms and arguments about the situation's futility. A huge infusion of education, money, and personnel will be needed to combat AIDS in Uganda.