HIV testing Every day, roughly 100 Ugandans acquire HIV. That number is falling, but not fast enough. New infections dropped sharply to 38,000 in 2023 from 52,000 in 2022, a 26.9 per cent decline. But from 2023 to 2024, the pace slowed dramatically, from 38,000 to 37,000, just a 2.6 per cent reduction. Adult HIV prevalence has edged down to 4.9 per cent in 2024 from 5.4 per cent in 2020, but this figure hides deep inequalities. Women are nearly twice as affected as men (6.4 per cent vs. 3.4 per cent), and adolescent girls and young women account for 78 per cent of new infections in the 15–24 age group. Geographically, cities are hotspots: Fort Portal (14 per cent), Mbarara (9.9 per cent), and Gulu (9.6 per cent). AIDS-related deaths stood at 20,000 in 2024, a 64 per cent decline since 2010, but still 20,000 lives were lost. With just four years to the 2030 deadline to end HIV/AIDS as a public health threat, Uganda stands at a critical crossroads. THE 2030 TARGETS AND THE GAPS In 2015, the United Nations adopted the Sustainable Development Goals (SDGs), with SDG 3.3 explicitly calling for an end to the AIDS epidemic by 2030. At the June 2021 UN General Assembly High-Level Meeting on AIDS, member states, including Uganda, committed to a 90 per cent reduction in new HIV infections and AIDS-related deaths from 2010 baseline levels, and to achieving the 95-95-95 treatment targets – meaning 95 per cent of people living with HIV (PLHIV) diagnosed, 95 per cent of those on treatment, and 95 per cent of those on treatment virally suppressed. Here is where Uganda stands: On the treatment side, Uganda is close. Viral suppression stands at 97 per cent, exceeding the 95 per cent target. However, diagnosis (94 per cent) and treatment coverage (90 per cent) still fall short, meaning thousands of Ugandans living with HIV remain either undiagnosed or not yet on treatment. On prevention, the gap is stark. Uganda recorded 37,000 new infections in 2024 against a target of fewer than 9,600, meaning new infections must fall by another 74 per cent in just four years. AIDS-related deaths paint an equally sobering picture: at 20,000, they remain more than double the 2030 target of 5,600. WHAT IS DRIVING NEW INFECTIONS AND AIDS DEATHS? Risky behaviours and complacency. Multiple sexual partners, low condom use, and transactional sex continue to drive new infections. A growing belief that antiretroviral therapy (ART) has made HIV a manageable condition rather than a life-threatening one is fuelling dangerous complacency and delays in seeking care. Gaps in testing and prevention access. One in ten Ugandans living with HIV does not know their status. PrEP (pre-exposure prophylaxis), PEP (post-exposure prophylaxis), and HIV testing remain out of reach for many, particularly in rural areas and among the most vulnerable populations such as adolescent girls and young women, sex workers, and fishing communities. Disproportionate burden on young women and girls. Poverty and unemployment drive many young women into transactional sex, gender inequality limits their ability to negotiate safe sex, and gender-based violence leaves them with little power to protect themselves. Addressing these structural drivers is just as important as the biomedical response. Without it, young women will continue to bear a disproportionate share of Uganda’s HIV burden. WHAT UGANDA MUST DO NOW Accelerate prevention. The ministry of Health should urgently scale up PrEP, HIV self-testing, and community outreach, prioritising hotspot cities such as Fort Portal, Mbarara, and Gulu as well as fishing communities and transport corridors. But prevention cannot stop at biomedical tools. Poverty and gender-based violence must be tackled directly through targeted economic empowerment programmes such as vocational training, microfinance, and income-generating initiatives that give young women financial independence and real alternatives to transactional sex. CLOSE THE TESTING AND TREATMENT GAPSMobile testing units, door-to-door campaigns, and index testing can find those still undiagnosed. HIV testing and treatment should be integrated into every routine health encounter so that no opportunity to test and treat is missed. Keep people on treatment. Getting people on treatment is only half the battle — keeping them there is where Uganda’s 20,000 annual AIDS deaths are won or lost. SMS reminders, multi-month drug dispensing, peer support groups, and active tracing of those lost to follow-up must be scaled up and treated with the same urgency as finding new cases. Uganda has proven it can fight HIV. The 64 per cent decline in AIDS-related deaths and 61 per cent reduction in new infections since 2010 are real, hard-won gains. But progress is not the same as finishing. With 37,000 new infections and 20,000 deaths still occurring every year, the epidemic has slowed, but it has not ended. The 2030 deadline is four years away, and the gap remains large. Closing it demands urgent, coordinated action from government, development partners, and communities. The clock is running and it will not wait. The writer is an expert associate at the Blueprint Consortium Africa, Kampala.The post Against the clock: Can Uganda end HIV/AIDS by 2030? appeared first on The Observer.