KAMPALA— Uganda, once a global leader in reducing HIV/AIDS prevalence, now faces a sobering reversal—one that disproportionately threatens the country’s women and girls. A 2025 policy brief by the Economic Policy Research Centre (EPRC) reveals a gendered resurgence in new HIV infections, raising alarm among health experts, policymakers, and advocates for women’s health.
Despite decades of public health gains, a combination of risky behavior, weakening awareness, digital-age exploitation, and funding shortfalls is driving a dangerous uptick in female infections. The EPRC warns that unless Uganda swiftly adapts its HIV response, it risks unraveling hard-won progress.
A Gendered Epidemic: When the Numbers Speak
The most troubling data points are also the clearest: while HIV infections among men are declining, infections among women are on the rise, especially among adolescents and young adults.
In 2010, 86.7 percent of new HIV infections among adolescents aged 10–19 were female. By 2023, that number had climbed to 89.4 percent. For women aged 15–24, their share of new infections rose from 73.5 percent to 80 percent, and among adults aged 15 and above, from 58 percent to 66.7 percent.
The sharp contrast with male infection rates suggests a crisis not just of exposure, but of social, economic, and behavioral inequity. It is not that women are inherently more susceptible, but that gendered vulnerabilities—many of them preventable—are being left unaddressed.
Behind the Numbers: Social and Behavioral Catalysts
The EPRC points to a complex mix of factors fueling this trend. One is a glaring disparity in risky sexual behavior. While 23 percent of men reported having non-regular sexual partners in the past year (compared to 13 percent of women), only 3 percent of these men used condoms, versus 14 percent of women. These patterns of unprotected sex—especially in transactional or casual encounters—put women at higher risk of exposure.
Sexually transmitted infections (STIs), which increase susceptibility to HIV, are also significantly more prevalent among women. In 2022, 35.4 percent of Ugandan women aged 15–49 reported experiencing STI symptoms, compared to just 18.7 percent of men. The report also underscores the growing role of online-enabled transactional sex, where economically vulnerable young women engage in unprotected relationships with older, wealthier men, often under coercive or exploitative circumstances.
Perhaps most unsettling is the diminishing fear of HIV among young people. As antiretroviral treatments have become more accessible and effective, many young women reportedly view HIV as less of a threat than unintended pregnancy, leading to reduced condom use and lower prevention efforts.
Urban Hotspots and the Testing Divide
Uganda’s major cities are now ground zero for new infections. In 2023 alone, Kampala recorded 2,800 new HIV cases, far outpacing Lira (600), Mbarara (491), Gulu (460), and Masaka (437). These numbers track closely with the report’s reference to a “booming night economy”—a euphemism for nightlife culture, sex work, and substance use, which collectively contribute to higher-risk environments for youth.
Despite these risks, HIV testing remains alarmingly low among men, with 27.4 percent of Ugandan men reporting they have never tested, compared to 13.5 percent of women. Among adolescents aged 15–19, just 28.5 percent of males knew where to access HIV testing services, versus 49.9 percent of females. Stigma, fear of disclosure, and inadequate health outreach to men have left a critical blind spot in the country’s HIV prevention efforts.
A Shrinking Budget, A Bigger Threat
As the crisis deepens, the resources to fight it are thinning. Uganda’s HIV/AIDS funding gap has more than doubled in recent years, from USD 77 million in 2021 to USD 185 million in 2023. Donor dependency remains worryingly high, with PEPFAR contributing over 61 percent of all external support. Meanwhile, the Ugandan government’s financial commitment remains modest, rising only from 13.6 percent to 14 percent—a figure experts warn is not sustainable in the face of donor fatigue and shifting global priorities.
This shortfall threatens the country’s goal of eliminating new HIV infections by 2030, a target that now looks increasingly out of reach without a serious investment in both strategy and finance.
Charting a New Path: Urgent Policy Shifts Needed
The EPRC recommends a multifaceted, gender-sensitive approach to reverse these trends. Central to this is empowering women economically and psychologically, reducing the reliance on transactional sex, and equipping them with the knowledge and agency to make informed sexual health choices.
The report also urges crackdowns on online commercial sex platforms, calling on the Uganda Communications Commission to enforce laws that prohibit the digital facilitation of sex work. Simultaneously, it highlights the need for targeted condom campaigns, particularly for men, who remain statistically less likely to use them with non-regular partners.
City-focused awareness drives are critical, especially in nightlife zones, where many infections originate. Testing initiatives must also be redesigned to better reach men—especially youth—whose reluctance to test continues to hinder detection and treatment.
Most importantly, Uganda must increase its domestic investment in HIV programming, taking cues from international donor volatility and building a more resilient, locally driven response.
The Cost of Complacency
The EPRC’s findings are more than a warning—they are a roadmap. Without urgent action, Uganda risks undoing decades of progress in its battle against HIV/AIDS. The epidemic is changing shape, increasingly infecting young women and exploiting gaps in urban and digital landscapes.
But the solutions are not out of reach. With stronger local funding, gender-specific policies, and a renewed commitment to prevention, the goal of zero new infections by 2030 can still be realized.
This is not just a health crisis—it is a reflection of how inequality, culture, and economic strain continue to shape life and death for Uganda’s most vulnerable. And in that truth lies the greatest urgency of all.
