| Chapter 1: | Introduction |
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in low-income nations are infected with this strain, it may not easily be controlled by existing HIV drugs, which is a danger to public health.
HAART in Uganda
Because this study explores HAART adherence behavior in Uganda, it is important to give a brief background about the study area. Uganda is located in sub-Saharan East Africa, and it is about the size of the state of Oregon. The country occupies an area of approximately 93,070 square miles with a 2007 estimated population of 32 million people (USDS, 2008). The majority of people in Uganda live under the international poverty line, as evidenced by the 2009 national gross national income (GNI) per capita of $460 (U.S.) (World Bank, 2011). One of the reasons why Uganda was selected for this study is that it was one of the first nations to experience a very high HIV incidence, especially in the 1980s and 1990s. Although statistics do not exist, Uganda also had a drastic drop in the incidence of HIV/AIDS between the mid-1990s and the early 2000s (AVERTing, 2008). By 2006, it was estimated that 2 million Ugandans had been infected with HIV and about 1 million had died of AIDS-related causes (Uganda Ministry of Health, 2006). It remains a controversy as to when the first HIV case occurred in Uganda. However, it is speculated that despite the fact that HIV in Uganda was first diagnosed in two cases in 1982, the first incidences of HIV may have emerged soon after the 1978–1979 civil war that deposed Idi Amin Dada’s political regime (Buve, Bishikwabo-Ssarhaza, & Mutangadura, 2002; AVERTing, 2008).
Although early HIV treatment in Uganda is not well documented, HAART was introduced in the United States and Uganda at about the same time (1996 and 1997, respectively). Unfortunately, the anti-HIV drug cost was so high that the majority of those affected in Uganda could not afford these drugs (MOH, 2003; Mugyenyi et al., 2006). By 2000, very few HAART-providing centers existed, and to the greatest extent they served a clique of Uganda’s elite who could afford the cost of the drugs (MOH, 2003; UNAIDS, 2006c). Not until about 2004