Uganda Refugee Survey Shows Low Prevalence of HIV and Strong Progress Towards Controlling the HIV Epidemic

Newly released data from the Uganda Refugee Population-based HIV Impact Assessment (RUPHIA) survey show a low (1.5 percent) prevalence of HIV among adults aged 15 years and older living in Ugandan refugee settlements. RUPHIA also found, that among refugee populations, Uganda is making strong progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) targets for controlling the HIV epidemic – which call for 95 percent of people living with HIV to be aware of their status, 95 percent of those aware of their status to be on ART, and 95 percent of those on ART to achieve viral load suppression.

In fact, among survey respondents in 2021, 82 percent of adults living with HIV were aware of their status; 90 percent of adults aware of their status were receiving antiretroviral therapy (ART); and 93 percent of adults on ART were virally suppressed below detectable levels – meaning they cannot transmit HIV to sexual partners†.

The survey also shows that more than seven in ten people living with HIV in Ugandan refugee settlements had achieved viral suppression, whether they knew their HIV status or not. These findings indicate that while people living with HIV in Ugandan refugee settlements are aware of their HIV status, on treatment and are achieving viral suppression, additional effort is still needed to find and link more of these individuals to treatment to accelerate progress toward ending HIV.

PHIAs are large, nationally-representative surveys – implemented under the leadership of Ministries of Health, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), CDC and partners – that directly measure progress toward global targets for ending the HIV epidemic. RUPHIA, conducted from October to December 2021, sought to measure the impact of the HIV response, including prevalence of HIV and of viral load suppression, among adults living in Ugandan refugee settlements. Of the 1,250 eligible households, more than 93 percent (93.4%) or 1,168 completed a household interview.

“RUPHIA is the first household survey of its kind to assess the impact of HIV treatment and prevention services within Uganda’s refugee settlements,” said Lisa Nelson, MD, MPH, MSc, CDC-Uganda Country Director. “CDC commends all partners in this effort which has provided valuable data for improving programs designed to treat and prevent HIV infections in Uganda’s refugee settlements.”

Uganda is home to more than 1.5 million refugees – the third-largest refugee population in the world and the largest in sub-Saharan Africa. Ugandan refugee settlements house refugees and asylum seekers mostly from South Sudan, Democratic Republic of Congo, Burundi, and other countries. The asylum seekers and refugees, nearly 80 percent of whom are women and children, co-exist with the communities that host them. Conflict and displacement make women and children, particularly girls, disproportionately vulnerable to HIV.

Refugees frequently face stigma, both because of their status as refugees and because of the common misconception that HIV prevalence is higher among refugees than in host communities.¹ RUPHIA data show a lower HIV prevalence of 1.5 percent among adults living in Ugandan refugee settlements compared to 5.8 percent for Uganda’s general population – as reported in UPHIA 2020.

Since 2017, CDC Uganda has supported HIV treatment and prevention services in Ugandan refugee settlements through its partnership with Infectious Diseases Institute (IDI) in the College of Health Sciences at Makerere University and Baylor Uganda. As part of the country’s Refugee Response plan, these partners support monitoring for new and existing cases of HIV at Ugandan border crossings and refugee settlements, help link clients to HIV treatment, and provide important laboratory services, including a safe and reliable system for transporting samples to the lab.

Today, nearly 2,500 refugees are currently receiving ART through health facilities supported by CDC and IDI. With support from CDC, IDI has established more than 25 health care facilities that are accredited to offer ART and TB services within Ugandan refugee settlements – all of which are connected to the national laboratory network system.

As a key PEPFAR implementing partner, CDC supports countries to effectively respond to their HIV epidemics and other global health threats, ultimately protecting Americans at home.

RUPHIA was led by the Government of Uganda (GOU) through the Ministry of Health (MOH), with funding from PEPFAR and technical assistance from CDC. The survey was implemented by ICAP at Columbia University and MOH in collaboration with other GOU entities including the Uganda Virus Research Institute , Office of the Prime Minister , the Uganda Bureau of Statistics , and the United Nations High Commissioner for Refugees (UNHCR).

As a key PEPFAR implementing partner, CDC supports countries to effectively respond to their HIV epidemics and other global health threats, ultimately protecting Americans at home. With support from PEPFAR, CDC works with partners to implement solutions that have transformed some of the world’s most severe HIV epidemics. As part of the PHIA surveys, CDC lends expertise in epidemiology, laboratory science, and data analysis to help partners design and implement PHIA surveys and rapidly harness the results for program improvement.

† These findings are based on a denominator of between 25 and 49 participants and should be interpreted with caution.