Only 3% of men use condoms in casual sex

Uganda, once hailed globally for its early and effective response to the HIV/Aids epidemic, is now at a dangerous crossroads.

A new 2025 policy brief by the Economic Policy Research Centre (EPRC) reveals a troubling reversal in HIV trends— one that is overwhelmingly gendered, disproportionately affecting young women and adolescent girls.

After decades of public health campaigns that once flattened infection curves, Uganda is now confronting a resurgence in new HIV infections, fueled by shifting behavior, widening structural inequalities, digital-age exploitation, and a growing funding crisis. The EPRC’s analysis is more than a data snapshot—it’s a warning that decades of hard-fought progress risk being lost, unless the country urgently recalibrates its approach.

At the heart of this crisis lies a total contradiction: while HIV infections among Ugandan men are declining, infections among women are rising sharply. In 2010, 86.7 per cent of all new adolescent HIV infections (ages 10–19) were among females. By 2023, that figure had climbed to 89.4 per cent.

Among women aged 15–24, the share of new infections rose from 73.5 per cent to 80 per- cent, and among all women aged 15 and older, from 58 per cent to 66.7 per cent. The disparity is not rooted in biology, but in socioeconomic disadvantage, behavioral risk patterns and systemic neglect.

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 per cent of men reported having non-regular sexual partners in the past year (compared to 13 per cent of women), only three (3) per cent of these men used condoms, versus 14 per cent 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 per cent of Ugandan women aged 15–49 reported experiencing STI symptoms, compared to just 18.7 per cent 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 per cent of Ugandan men reporting they have never tested, compared to 13.5 per cent of women.

Among adolescents aged 15–19, just 28.5 per cent of males knew where to access HIV testing services, versus 49.9 per cent 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.

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 $77 million in 2021 to $185 million in 2023. Donor dependency remains worryingly high, with PEPFAR contributing over 61 per cent of all external support.

Meanwhile, the Ugandan government’s financial commitment remains modest, rising only from 13.6 per cent to 14 per cent—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.

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.

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.