As Uganda marked World AIDS Day on December 1, health experts in the Teso subregion warned that poor adherence to antiretroviral therapy (ART) is undermining progress in controlling HIV. While national figures show a sustained drop in prevalence, inconsistent drug intake—especially among adolescents and young adults—is threatening treatment outcomes and fueling drug resistance.
Adherence to ART requires taking medication exactly as prescribed: the right dose, at the right time, every day. Dr. Katende Ivan, HIV Clinical Care Coordinator at Soroti Regional Referral Hospital, says even small lapses can have serious consequences.
“Even a few missed doses can result in treatment failure, higher viral loads, and increased risk of drug resistance,” he explains. “We have patients whose health deteriorates simply because they forget doses, skip medication, or stop treatment temporarily.”
Drivers of Poor Adherence
Substance and alcohol abuse are major contributors. Dr. Katende notes that intoxication impairs judgment, causing patients to forget their medication. Economic hardship also plays a role, with some unable to afford transport to health facilities, while frequent movement between clinics disrupts continuity of care. Cultural beliefs and misinformation further complicate adherence. Some patients stop taking medication after being prayed for, mistakenly believing they have been cured.
Adolescents face particular barriers, including delayed disclosure of their HIV status by parents or guardians. Stigma in schools and social settings also leads many to hide or skip medication.
“If a child does not understand why they are taking these drugs, especially during adolescence, they may hide or skip doses,” Dr. Katende says. “Some conceal their medication even from partners, which leads to poor outcomes.”
Young adults aged 15 to 45 also struggle with adherence, often due to concerns about relationships, image, or social acceptance. This age group represents the majority of new infections and treatment lapses in Teso.
At Kaberamaido General Hospital, HIV focal person Cuthbert Oyugi observes similar patterns. “Many adolescents and young adults stop treatment when entering new relationships or moving to boarding schools. They don’t want to be seen taking medicines,” he says. “Parents may tell children to take medication but fail to guide them, and adolescents often rebel or ignore treatment.”
Consequences of Non-Adherence
The effects can be severe. When patients stop taking ART, viral loads rise, immunity drops, and the risk of opportunistic infections—such as tuberculosis and meningitis—increases. These illnesses can quickly become fatal.
At Kaberamaido General Hospital, the HIV clinic serves 1,450 to 1,500 clients. Adolescents account for the highest proportion of those “lost to follow-up”—patients who stop coming for treatment. Health workers attempt to trace them, understand the reasons for interruption, and provide tailored support.
Burden of HIV in Teso
Teso’s overall prevalence stands at 3.3%, but rates vary widely. Soroti City’s prevalence is 11.6%, meaning roughly 12 in every 100 residents are living with HIV.
In 2024, the region recorded 1,110 new infections—a decline from previous years, though still worryingly high. Soroti City registered 220 new cases in 2024, down from 294 in 2023.
Rapid urbanization, increased alcohol and drug use, school dropouts, and high levels of multiple sexual partnerships continue to drive transmission. Surveys show 23% of men report having more than one sexual partner. Historical displacement from past insurgencies has also contributed to the region’s high burden.
Rising Drug Resistance
Non-adherence is closely linked to drug-resistant HIV. When patients take medication inconsistently, the virus can mutate, rendering standard drugs ineffective.
Dr. Katende notes that samples are routinely tested at the Central Public Health Laboratories (CPHL), where specialists assess resistance and adjust treatment regimens. Drug-resistant strains threaten both individual health and community-wide progress.
Uganda’s National Progress—and Fragile Gains
Despite regional challenges, Uganda has made significant national progress. Prevalence has dropped from 30% in 1992 to 4.9% today. The country is nearing the UNAIDS 95-95-95 targets: 94% of people living with HIV know their status, 90% of those are on treatment, and 97% of those on treatment are virally suppressed.
But the gains remain vulnerable. Uganda recorded 37,000 new infections in 2024—more than 100 per day. Although new infections have fallen 61% over the past decade, the absolute numbers remain high.
“Understanding why someone stopped taking their medication is essential,” Oyugi says. “Only then can we help them find a workable solution.”
Parents and caregivers are also urged to take a more active role in supporting young people on treatment. Stigma—at home, in schools, and in communities—remains a major barrier.
Rwengabo Victor from the Uganda AIDS Commission says the region must remain vigilant. “Even as national numbers fall, pockets of high transmission like Teso persist. Consistent adherence is key to preventing drug resistance and reducing new infections.”
As World AIDS Day calls for renewed commitment, health workers say Teso’s fight can still be won—but only if communities, families, and patients work together to ensure uninterrupted treatment.
Community-based ART models, adolescent-friendly services, age-appropriate education, and integrated HIV programs are beginning to make a difference. With coordinated action and sustained support, Teso can overcome its challenges and secure a healthier future.
