During the 1990s, HIV infection rates in Uganda fell, from around 15
percent to around 6 percent, a success that is unique in Africa. In 2000,
researchers at USAID began to inquire why HIV infection rates had fallen
only in Uganda and not in other African countries. USAID's conclusion
was that most countries relied too much on condom promotion alone, but
Uganda had a range of programs that encouraged abstinence and faithfulness
as well as condoms—a
strategy that came to be known as ABC—for Abstain, Be
faithful, or use Condoms.
There is controversy over the reasons for the decline of HIV/AIDS in
Uganda. At stake in this debate are not only scientific inquiry and substantial
United States AIDS funding, but also potentially the health and lives
of millions of people.
The Ugandan AIDS Commission (UAC) appears to be solidly behind a comprehensive
sex education program to reduce the transmission of HIV through a three-pronged
promotion of "behavior change" among the general population—specifically:
- Abstinence to the sexually inactive,
- Monogamy to married couples, and
- Condoms to prevent STD transmission for almost everyone who is sexually
active.
The Sexuality Information and Education Council of the United States (SIECUS)
describes the Ugandan program as a comprehensive plan involving both abstinence
for those who wish to remain sexually inactive, and the use of
condoms for STD prevention for those who wish to be sexually active.
SIECUS wrote that: "Uganda has been lauded as the most successful
HIV/AIDS prevention case in Africa, as it is the only country in sub-Saharan
Africa where the incidence of HIV/AIDS has decreased."
The 1994-1998 National Operational Plan for HIV/AIDS/STD Prevention,
Care and Support of the Uganda AIDS Commission states:
"The main emphasis of the Plan will be prevention of HIV-infection
through behaviour change, promotion of STD-care and condom use for targeted
groups of people with focused educational messages. The promotion of
behaviour change will focus not only on the individual behaviour, but
will equally focus on the collective behaviours, and the norms and the
values of the community."
"In order to achieve this," indicates
the Plan, "it is necessary to give first priority to children
and youth and to start addressing norms and values right from school
entry, gradually making it more specific as the child grows." The
second priority of the Plan is to address the status and needs of women,
including rural women, and the third is to address cultural and traditional
customs and specific sites with concentration of risk behaviours."
The UAC Web site features a "Behavior Change" sheet
titled "A very simple message." It says in part:
"We thought that the AIDS epidemic was just a little river that
we could dam easily. Now we realize that it is a real flood that rises
inexorably. Many people start loosing hope; they forget that if you cannot
dam a flood you can escape by getting into a boat. People are different,
they need different boats."
"There are three kinds of boats called: 'Abstinence,' 'Fidelity'
and 'Condom.' People argued: 'Do not stay in the water, get into
a boat.' The boat of your choice. If you feel that you cannot stand the
life on board, do not fall back into the water; switch from one boat
to another."
The National Strategic Framework for HIV/AIDS Activities in Uganda
(NSF) has published an executive summary, which notes:
- In Uganda, "There has been an overall
decline in HIV positive sero prevalence rates...from 30 to about
10 percent between 1992 and 1996...it appears to have stagnated since."
- " ...the mechanisms that produced this reduction are not
fully understood. Owing to weak monitoring, it is not possible to
apportion the observed decline between the three factors of abstaining,
being faithful to one's partner, and condom use."
According to Johns Hopkins University,
the Ugandan program as a comprehensive plan involving both abstinence
for those who wish to remain sexually inactive, and STD prevention
for those who wish to be sexually active. They note that at one time,
Uganda had the highest HIV infection rate in the world, and that it is
the only country in sub-Saharan Africa where the incidence of AIDS has
decreased.
^TOP EAST AFRICAN HOPE >
www.nybooks.com/articles/17963
http://www.religioustolerance.org/safer_sex_uganda.htm
http://www.fao.org/docrep/t2942e/t2942e02.htm
The Behavior Change sheet
was adapted from B. Joomet and T. Mugolola's book " The Fleet
of Hope: teachers book." Unfortunately, neither Amazon nor Barnes
and Noble list the book.
http://www.religioustolerance.org/safer_sex_uganda.htm
April 1999 issue of Population
Reports, published by the Population Information Program, of the
Center for Communication Programs, at Johns Hopkins School of Public
Health
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