Public health specialists in Uganda are calling for new strategies to identify individuals living with HIV who remain unaware of their status. Traditional facility-based testing alone may not be enough as the population continues to grow. This call follows the release of preliminary findings of the 2025 Uganda Population-based HIV Impact Assessment (UPHIA). The findings show that although Uganda has made significant progress in HIV treatment and viral suppression, a sizeable number of people living with HIV still do not know their status.
Kenneth Mwehonge, the Executive Director of the Coalition for Health Promotion and Social Development, says health authorities need to move beyond conventional facility-based testing. They should deliberately target communities and population groups where new and undiagnosed infections are concentrated. Mwehonge notes that the country already has information on geographical and population hotspots with the highest HIV burden. This information should guide targeted testing. Uganda could also borrow from the public health response used during outbreaks like Ebola. Health workers traced and tested contacts of confirmed cases during Ebola.
The UPHIA survey was conducted between July and September 2025 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. All participants were tested for HIV, regardless of whether they already knew their status. At the launch of the preliminary findings, Health Ministry Permanent Secretary Dr Diana Atwine said 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.
Dr Sam Biraro, a researcher at Makerere University School of Public Health, said the assessment suggests that an estimated 225,000 people may be living with HIV without knowing their status. This translates to about 15 per cent of those who tested positive for HIV during the survey. Biraro explained that for every 100 people who tested positive for HIV, 85 already knew their status, while 15 were unaware that they were living with the virus. These individuals are not receiving treatment.
The survey shows 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. The Central 1 region, comprising Wakiso, Mpigi, and greater Masaka, had a prevalence of 7.3 per cent. Karamoja recorded the lowest prevalence at 1.3 per cent, followed by West Nile at 1.4 per cent. HIV prevalence in Kampala stood at 5.4 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. This pattern has remained largely unchanged since 2020. Overall, the findings estimate that about 1.496 million adults aged 15 years and above are living with HIV in Uganda. Health Minister Dr Chris Baryomunsi said 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.
Dr Baryomunsi noted that almost everyone who knows they are living with HIV is on treatment, and almost everyone on treatment has suppressed the virus. The biggest remaining gap is at the very start: about one in seven people living with HIV do not know their status. Baryomunsi said Uganda can increase the proportion of people who know their HIV status from the current 85 per cent to the national target of 95 per cent by 2030 if people are given more options for testing, including HIV self-testing.
Key points
- Uganda needs to target communities and population groups with high HIV burden for testing.
- The country has made significant progress in HIV treatment and viral suppression.
- An estimated 225,000 people may be living with HIV without knowing their status.
