The Ugandan government is often praised for the progress made in reducing the HIV prevalence rate to only six per cent in 2002 and lowering very high infection rates in a region ravaged by AIDS.
However, the rate has increased in recent years and Tonny Takenzire of National Guidance and Empowerment Network in Uganda (NGEN) suggests it is now closer to 10 oer cent. "We have clinics out in the countryside and what we find out there is not the picture we get from the government," he says.
Data on both HIV prevalence and incidence show rising trends since 2000, which is attributed to increased sexual risk behaviour, condom shortage and the widely debated 'ABC' policy which has shifted the focus from condom use to abstinence and faithfulness.
Tonny Takenzire lives with HIV: "I have been on medications for eight years, and working with NGEN, I have been trying to shoot down the idea of abstinence."
Though ABC stands for abstinence, being faithful and condom use, Beatrice Were of ActionAid Uganda states that the 'ABC' policy has now become a policy that emphasises abstinence and fidelity over condom use. "The 'C' part is now mainly silent," she said. This policy has dangerously tilted Uganda's previously balanced approach, which had proved successful.
The ABC programme, also known as the "abstinence only" programme, has been pioneered by the US and teaches that abstinence from sex is the only effective method of HIV prevention. A New York based group called Human Rights Watch says that the funding for abstinence is due to President Bush's conservative Christian views, similar to those of Uganda's first lady.
In the 2003 President's Emergency Plan For Aids Relief (PEPFAR), during which Bush pledged $15 billion to combat the Aids pandemic in the worst-afflicted countries, the total sum granted to Uganda was $201 million over two years. However, funds come with conditions: at least one-third of all prevention money must go to abstinence-only projects.
Demographic and health surveys have shown that Ugandans start having sex at an early age, and that more than 50 per cent of Ugandan girls have had sex by age seventeen, usually with someone older. Abstinence-only programmes therefore fail in educating young women about condoms and safer sex for the reason that this undermines the goal of abstinence.
While almost one-third of Uganda's adult population was estimated to be infected with HIV in the 1980s, this fell to about 15 per cent in the early 1990s, and to six per cent in 2002. Donor funding was previously biased towards condom promotion, and it is this, together with widespread HIV testing and high-level political leadership, that has helped to fight AIDS in Uganda.
However, Eric Hawthorn, a Department for International Development (DFID) Government Official, claims that abstinence is an appropriate approach to preventing infection in some risk groups. He says that "it is simplistic and wrong to explain the fact that HIV/AIDS prevalence is no longer falling by reference to the abstinence prevention agenda". There are a large number of reasons why new infections are still high including biological, behavioural, socio-economic and cultural factors. Mr Takenzire suggests that people have become more careless as they believe they can be cured for HIV.
Stephen Lewis, the United Nations' special envoy for HIV and AIDS in Africa, is concerned about the reduced availability of condoms in the country and a tripling of their price. In a press conference at the end of August, he said that the government had been "acting under the influence of the religious right in the US by running the multibillion dollar campaign emphasising abstinence".
Regulation recently introduced forbids any national or international non-governmental organisation distributing condoms in high schools during AIDS education classes, in which many sexually active youth can be reached. Billboards across the country are putting forward abstinence-only messages, and so the condom message is lost. Moves such as calling for a census of virgins in the country are also abundant.
A new programme known as the Presidential Initiative on AIDS Strategy for Communication to Youth (PIASCY) was launched by the Government of Uganda in 2001, to expand HIV prevention education to all primary and secondary schools. Funded and conceived by the United States, PIASCY provides abstinence-until-marriage messages, and teachers interviewed by Human Rights Watch said that PIASCY trainers had encouraged them to omit information about condoms.
Research by Human Rights Watch has also indicated that Ugandan women who abstain until married and who remain faithful in their marriage still face a very high risk of HIV due to their husbands' infidelity or prior HIV infection. Abstinence education condones marriage without providing information about its risks and so fails to address the risk of HIV to married women.
However, Mr Takenzire says that condoms are now coming back in large numbers and people are beginning to use them again. The Ugandan government is seeking to pursue a comprehensive prevention strategy to address this wide range of issues through a new five year HIV/AIDS strategic plan. This includes abstinence in addition to a wide range of other interventions.
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