On January 18, 2007, in Kampala, Uganda, International and Ugandan AIDS
researchers concluded a three-day conference to identify what works in
reducing the AIDS pandemic in sub-Saharan Africa. Participants
included researchers and pioneers of the Behavior-Based
Uganda Model and sought to advance understanding of the practical, scale-realistic,
and empirically demonstrated solutions.
The co-chairs of the symposium were Dr. Edward Green, from Harvard University
School of Public Health, Dr. Samuel Luboga, Makerere University, and
Rt. Rev. Dr. David Zac Niringiye, Anglican Church of Uganda. The symposium
included religious leaders, policy makers, government leaders and historians;
including Dr. Tom Kenyon, Deputy Director of the President's Emergency
Program for AIDS Relief; Dr. Sam Okware, Ugandan Ministry of Health;
Nsaba Buturo, Minister of Ethics and Integrity; Dr. Norman Hearst, University
of California, San Francisco; Saifuddin Ahmed, Johns Hopkins University;
Sister Miriam Duggan, Irish Franciscan Missionary Sisters for Africa.
The symposium was sponsored by funding from the Templeton Foundation
and concluded with the following summary:
- In every example in Africa of prevalence rates falling, there have
been significant declines in casual, multi-partner sex in the previous
years. Thus, when more men and women practice mutual fidelity, national
prevalence rates fall.
- Abstinence works, and can and should be promoted. It works best as
a broader character formation effort that includes teaching skills
in forming friendships, understanding peer pressures, fostering self
respect and respect for others, what it means to fall in love, what
it means to take responsibility for one's own behavior, and how
certain actions and decisions can have life-long consequences.
- Regarding condoms, two problems emerged in Ugandan and African studies:
1) inconsistency of use, 2) acquiring a false sense of security that
results in more risky behavior.
- Poverty is not associated with infection rates in the way usually
thought. Often the wealthier populations have higher HIV infection
rates, which may be influenced by factors such as mobility, disposable
income for alcohol and recreation, urban residence, which all can lead
to a greater number of sex partners.
- Collaboration with community groups is important to fight against
AIDS. In Uganda, faith-based organizations (FBOs) play an important
role and are best positioned to promote health care and education.
In addition, women's and men's associations, care groups,
youth organizations, traditional healers, and local media need to work
with governmental leadership to foster new norms of sexual behavior.
According to Dr. Edward Green, "HIV prevalence appears to be starting
to rise again after years of decline. This may be caused by less emphasis
on messages stressing the importance of fidelity and more focus on condom
promotion and other risk reduction solutions." If this is true,
this is tragic and needs to be acknowledged and addressed immediately—a
growing body of research from Africa demonstrates that relying on condoms
alone will not reduce HIV infection rates in Africa.
Dr. Edward Green says, "Loving faithfully and zero grazing were
the main messages for most Ugandans in the earlier national prevention
program of the late 1980s and early 1990s; it is less strong
now and as a result HIV prevalence appears to be starting to rise again
after years of decline.
One resolution and recommendation from the symposium states that, "Condoms
should not be the dominant intervention for the general populations of
Africa, in line with scientific evidence to date." Dr. Green added, "A
simple homegrown African approach works better than the international
medical technical approach at least in prevention. It is low cost, low
tech, sustainable and culturally acceptable."
A complete list of symposium papers is available at http://ugandasymposium.jot.com/WikeHome
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