Why HIV prevalence is highest among the middle-aged in Uganda

COMMENT | CAROLYNE MUYAMA | At a recent coronation event for the Omukama of Tooro, His Majesty Edward Kijanangoma Rukidi Nyabongo I, President Yoweri Kaguta Museveni urged local leadership to prioritise addressing the region’s high HIV prevalence, notably contrasting it with Karamoja, where HIV prevalence is lowest. That local call to action is backed by robust national data. This morning at the Uganda Media Centre, Health Minister Chris Baryomunsi released the findings of the Uganda Population-based HIV Impact Assessment (UPHIA 2025).

The comprehensive household survey serves as a vital health check for the nation. Following earlier surveys in 2016/2017 and 2020/2021, UPHIA 2025 measures key indicators such as HIV prevalence, new infections, and the extent to which Ugandans are achieving viral load suppression, helping us understand how our national programmes are performing. Uganda has lived in the shadow of the HIV epidemic for decades, transforming the widespread fear of the 1990s into a manageable reality thanks to relentless public health campaigns and antiretroviral therapy.

The ABC strategy championed by President Yoweri Kaguta Museveni and the First Lady, Janet Kataaha Museveni, went a long way in the fight against HIV/AIDS in the country. According to UPHIA 2025, the overall prevalence of HIV among adults aged 15 and older is 5.9%, with 7.3% among women and 4.1% among men, equating to 1,496,000 adults living with HIV. Among adults aged 15 to 64, national prevalence was 6.2% in 2016/17, dropped to 5.9% in 2020/21, and stabilised at 5.9% in 2025.

This indicates that government interventions and public health programs are impactful. Infection rates have stabilised, and effective treatment and viral suppression are sustaining millions of lives. However, the data also shows that HIV remains deeply embedded in our communities, signalling that we must shift from broad campaigns to targeted action.

Looking closely at the demographics, two major patterns emerge: the resilience of our teenagers and the heavy burden borne by women and middle-aged adults. HIV rates among teenagers are encouragingly low, with rates of 1.3% for girls and 0.6% for boys aged 15 to 19, indicating that youth-focused prevention messages over the past decade have had an impact. However, vulnerability rises sharply as people move into adulthood.

For women, prevalence climbs from 1.3%…