A quarterly international newsletter on sexuality, sexual health, and sexuality education.
Volume 2, Issue 3 - Winter 2002/2003
Ugandan Approach to HIV/AIDS Prevention
Uganda has been lauded as having one of the most successful HIV/AIDS prevention strategies in Africa, as it experienced significant reductions in HIV prevalence rates in the 1990s.
Under President Yoweri Museveni, who came to power in 1986 and helped to restore political stability, Uganda became the first African country to acknowledge the seriousness of the AIDS epidemic and vowed to focus its efforts on fighting the disease.
Uganda has invested heavily in training health workers, creating counseling networks, treating sexually transmitted diseases(STDs), and expanding HIV testing.
President Museveni's administration established The Ugandan National Task Force on AIDS in 1990. One year later, a multi-sector program began what has been dubbed ABC after its so-named key elements, "Abstinence,""Be Faithful" and "use Condoms."This comprehensive, behavior change approach to primary HIV prevention has attracted worldwide attention because many countries are now implementing their own version.The United States is also promoting it through its foreign aid program, USAID.
In October 2002,The Alan Guttmacher Institute (AGI) released an analysis of Uganda's successful reduction of HIV prevalence rates during the 1990s. In "Flexible but Comprehensive: Developing Country HIV Prevention Efforts Show Promise,"AGI's Director of Government Affairs Susan Cohen draws on the new analysis to illustrate that an integrated and comprehensive approach shows the most promise for slowing the spread of HIV.
In the various settings in which the model is being adapted, emphasis on any particular component varies according to such factors as cultural traditions, age, gender, and marital status of the target population.What is widely recognized as essential in successfully implementing the model -especially among adolescent and young adults where HIV infection has been spreading most rapidly-is that the approach must be both flexible and comprehensive.
In Uganda, the participation of faith-based groups, youth, women, and other grassroots sectors, combined with clear, forceful government leadership and donor support, resulted in broad community mobilization in support of delayed sexual onset, reductions in casual partnerships, and increases in condom use.
Scientific and policy experts around the world are analyzing the data to better understand what has worked so well in Uganda and how it can be replicated elsewhere. U.S.-based advocates of abstinence-only-untilmarriage programs, including those within the DHHS, are also exploring the data and seeking to attribute Uganda's success primarily to increased abstinence.
Conservative groups such as Focus on the Family have used the case study of Uganda to advocate their single-focused ideology, claiming that it was an increase in abstinence until marriage that accounted for the turnaround in HIV rates. Along with the fact that Uganda's experience cannot be used to justify a singlefocus, abstinence-only-until-marriage approach to HIV prevention for overseas export, the terms of the U.S. debate may be inappropriate in other country cultures. For example, Elizabeth Serlemitsos, chief of party for the communication component of Zambia's Integrated Health Programme, explains that "abstinence" simply means "delay" in her country -not until marriage but "maybe just until tomorrow."
While there is no reason to believe that USAID is currently supporting ABC as anything other than a comprehensive program, given the domestic policies driving the Bush Administration's aggressive support for a program model in the U.S. that focuses exclusively on promoting abstinence outside marriage and either ignores or actively opposes contraceptive and condom use, reproductive health and HIV advocates are looking at the future with caution.
This year, DHHS gained new authority to increase oversight of HIV prevention and treatment programs in developing countries. In August 2002, it led a team to Uganda "to better understand the role of abstinence education in the battle against HIV/ AIDS." In addition, USAID, along with DHHS, is more overt than ever recruiting so-called faith-based organizations as partners. An internal USAID working group is in the process of documenting the extent to which USAID promotes abstinence in the field.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) estimates that Uganda's prevalence rates declined in major urban areas from about 30 percent in 1990 to 14 percent in the late 1990s, and in non-urban areas from 13 percent in 1992 to about eight percent in the late 1990s. As Uganda is a largely rural country, national trends are similar to the situation in non-urban areas.
To better understand the cause of these declines,AGI analyzed data from nationally representative Demographic and Health Surveys of reproductive-age women conducted in 1988, 1995, and 2000, and of men conducted in 1995 and 2000 because "they provide evidence on key factors for the country as a whole, and may therefore more appropriately be applied to understanding changes in the national rates of HIV prevalence and incidence that would studies of particular areas of the country."
The analysis reveals that:
The analysis demonstrated that the contributions of sexual abstinence, multiple-partner reduction, and condom use all contributed to reduced exposure to HIV in Uganda.The evidence, like evidence in the U.S., highlights the importance of these successful comprehensive approaches to HIV prevention.
For more information, contact:
The Alan Guttmacher Institute (AGI)
120 Wall Street
New York, NY 10005 USA
Phone: 212.248.1111
Fax: 212.248.1951
E-mail: info@agi-usa.org
Web site: http://www.agi-usa.org
To download a copy of the AGI analysis: http://www.guttmacher.org/pubs/journals/gr050401.html
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