Public health specialists in Uganda are calling for a change in the country's HIV strategy to identify individuals living with HIV who remain unaware of their status. This call comes after the release of preliminary findings from the 2025 Uganda Population-based HIV Impact Assessment (UPHIA). The findings show that while Uganda has made significant progress in HIV treatment and viral suppression, a substantial number of people living with HIV still do not know their status.
According to Kenneth Mwehonge, executive director of the Coalition for Health Promotion and Social Development, health authorities need to move beyond conventional facility-based testing and target communities and population groups where new and undiagnosed infections are concentrated. Mwehonge suggests that the country already has information on geographical and population hotspots with the highest HIV burden, which should guide targeted testing.
The UPHIA survey, conducted between July and September 2025, was carried out by the Uganda Bureau of Statistics, the ministry of Health, Makerere University School of Public Health, and the Uganda Virus Research Institute. The survey covered 94.4 per cent of the 6,283 eligible households selected across the country, with all participants tested for HIV regardless of whether they already knew their status.
Health ministry permanent secretary Dr Diana Atwine stated that people living with HIV who remain unaware of their status and are not on treatment represent the country's biggest remaining gap in the HIV response. She noted that the findings provide important pointers on where health authorities need to concentrate their efforts. Atwine estimated that 150,000 or more people remain unaware of their HIV status.
However, Dr Sam Biraro, a researcher at Makerere University School of Public Health, suggests that the number of people living with HIV without knowing their status could be significantly higher. Biraro stated that for every 100 people who tested positive for HIV during the survey, 85 already knew their status, while 15 were unaware that they were living with the virus. This translates to about 225,000 people who may be living with HIV without knowing their status and, consequently, are not receiving treatment.
The survey also reveals significant regional differences in HIV prevalence. Southwestern Uganda recorded the highest prevalence at eight per cent, compared with the national average of 5.9 per cent. Karamoja recorded the lowest prevalence at 1.3 per cent, followed by West Nile at 1.4 per cent. Women continue to carry a higher burden of HIV, with prevalence estimated at 7.3 per cent compared with 4.1 per cent among men.
Health minister Dr Chris Baryomunsi noted that the country is encouraged by the progress made in ensuring that people who know their HIV status are enrolled on treatment and achieve viral suppression. He emphasized that almost everyone who knows they are living with HIV is on treatment, and almost everyone on treatment has suppressed the virus. Baryomunsi suggested that HIV self-testing could help close the remaining testing gap and enable the country to identify more people living with HIV who are currently unaware of their status.
Key points
- Uganda's HIV strategy needs to change to target communities and population groups with high HIV burden.
- The country has made significant progress in HIV treatment and viral suppression, but a substantial number of people living with HIV still do not know their status.
- The UPHIA survey estimates that about 1.496 million adults aged 15 years and above are living with HIV in Uganda.
