CONTENTS | ANB-BIA HOMEPAGE | WEEKLY NEWS
by Fred Kirungi, Uganda, January 1999
THEME = AIDS
Over 1.5 million Ugandans or 7.5% of the total population
are infected with HIV, the virus that causes AIDS
The good news is, that for the last five years, the rate of HIV infection has been dropping. According to the HIV/AIDS Surveillance Report released by the AIDS Control Programme (ACP) in the Ministry of Health (March 1998), the incidence of HIV among pregnant women in Kampala dropped from 30% in 1992 to 15% in 1997. The incidence of HIV among pregnant women is considered to be representative of that among sexually active adults. The presence of HIV among patients with Sexually Transmitted Diseases (STD)s also dropped from 44% in 1989 to 30 in 1997. This is particularly encouraging as STD patients have one of the highest chances of contracting HIV.
Since the ACP started monitoring the spread of HIV in 1989, the infection rates recorded in the various surveillance centres across the country, have followed a similar trend, rising each year to peak in 1992, before starting to fall in 1993. In Mbarara in western Uganda, for example, the rate of infection rose from 22% in 1989, to 30% in 1992, but had declined to 15% percent by 1996. In Mbale in eastern Uganda, it increased from 4% in 1989 to 15% in 1992, but had fallen to 7% by 1997. «The decline in HIV infection is due to behaviourial change,» says the ACP's Programme Manager, Dr. Elizabeth Madra. «Where people used to have multiple sex partners, they are sticking to one; where they used to have sexual contact at the early age of 15, they are waiting until 18 or 19; when they used to have unprotected sex, they are using condoms.»
The 1998 STD/HIV Surveillance Report shows that heterosexual contact with an infected partner, accounts for 75%-80% of HIV infections. Mother-to-child transmission, accounts for 18-22% of HIV cases. A 1995 survey, indicated that only 49% of people in the 15-19 age bracket had ever had sex, as compared to 71% in 1989. There was also a reduction in casual sexual relationships within the same age group, from 37% in 1989 to 21% in 1995. The change in sexual behaviour is due to a government-led education campaign on avoiding HIV infection.
Every imaginable public institution is involved in this campaign, ranging from the press to religious bodies, schools and non-governmental organisations (NGO)s. Even individuals have taken up the crusade. President Yoweri Museveni and a prominent Ugandan musician, Philly Lutaya, have been the most notable.
President Museveni has used every opportunity to warn people against HIV infection. He has mostly targeted young people and the army, advising them to abstain from sex until marriage. Philly Lutaya was the first Ugandan to publicly acknowledge that he was infected with HIV. At the time he made the declaration in 1988, many Ugandans doubted the existence of AIDS. He used his condition to convince them that the danger of AIDS was real, presenting himself as testimony to this. Until his death in 1989, he travelled countrywide, urging people to change their sexual behaviour.
«We tell people that there is no cure for AIDS, and the only way to avoid it, is to abstain from sex, or if they can't do that, to be faithful to their partner, and to use condoms,» says Madra of the ACP.
Straight Talk is a monthly newsletter with a circulation of over 30,000 copies. This publication spreads the following message, especially to adolescents who constitute one of the most vulnerable groups: «Our message is, that everyone is responsible for their bodies, and every adolescent can stay safe from AIDS.»
National statistics show, however, that adolescent girls get infected with HIV six times more than boys. Straight Talk editor, Anne Akia Sydler, attributes this to the fact that men prefer young girls who, they believe, are less likely to be infected. Such men, locally known as «sugar-daddies» on account of their age and relative wealth, entice the young girls with material things. «And since the girls have no bargaining power, they fall easy prey,» she says. «Straight Talk» is trying to equip these girls with bargaining and communication skills, so they are able to resist sugar-daddies.»
Moses Agwisagye is the Field Training Officer of the Uganda Youth Anti-AIDS Association, a youth NGO which disseminates information about AIDS and distributes condoms in schools. He says another reason for the high incidence of HIV among girls, is that they have no means of protecting themselves during sex. «Whereas the boys may use condoms whenever they want, girls can't insist that their partners use condoms». To change this situation, the Uganda Youth Anti-AIDS Association has started distributing female condoms among girls.
Dr Madra says that the high degree of AIDS awareness prevailing in Uganda, has not been easy to achieve. «At first, it was difficult to go around talking about sex and demonstrating how to use condoms, especially in schools.». Most religious groups have remained opposed to the promotion of the condom as a preventive measure, arguing that telling people to use condoms simply encourages promiscuity. Because of the fear of antagonising religious groups, government policy has been to promote condoms «quietly.» Dr Madra says: «We have, however, abandoned that policy because condoms are no longer the sensitive issue they used to be, and everyone is now talking about them». The ACP has distributed over 50 million condoms in the last two years.
Another problem was the delayed government response to the AIDS crisis. According to Nsubuga Yusuf, the Policy, Law and Ethics Co-ordinator of the Uganda AIDS Commission, a body established by the government to formulate policy and co-ordinate activities on AIDS prevention, the government did not, initially, take the problem of AIDS seriously. «Between 1982, when the first AIDS case was identified, and 1986, there was no official government response. The problem was left to NGOs, which responded in an ad hoc way. Rates of infection thus continued to rise,» he regrets.
This changed in 1986 with a change of government, and the realisation that the problem was fast getting out of hand. The government committed itself to fighting the scourge, establishing in 1986, the AIDS Control Programme in the Ministry of Health, to investigate and prevent HIV infection. «At this point, however, AIDS was considered simply a medical issue. It was later realised that AIDS was as much a cultural or social problem as a medical one,» explains Nsubuga. This led to the government's adoption of a multi-sectoral approach to fighting the scourge. Then followed the establishment of the Uganda AIDS Commission in 1992 to co-ordinate all AIDS activities in the country. Under this approach, the struggle against AIDS has broadened to include fighting poverty, cultural practices like polygamy and wife inheritance, and laws discriminating against women such as divorce laws, all of which increase the risk of HIV infection. «We think this approach is working, that is why we have declining rates», says Nsubuga.
Not everyone, however, is convinced that the rate of HIV infection is actually falling. Francis Mbaziira, Assistant Co-ordinator of Kamwokya Community Centre, a Catholic NGO that looks after AIDS victims, comments: «We have so far received 300 HIV infected people at our clinic this year (1998), as compared to 200 the whole of last year. This shows that the rate of infection is still rising.» He argues that the declining figures recorded by the AIDS Control Programme are due to the fact that a growing number of infected people are resorting to private treatment, as opposed to visiting established HIV surveillance centres.
What everyone agrees on is, that there is no room for complacency. As Dr. Madra puts it: «The present rate of infection is still high. More behaviourial change is needed. The fight must be intensified.» Given the widespread poverty and some entrenched cultural practices, such as polygamy (30% of all married women are in polygamous marriages), the war against HIV will not be an easy one to win.
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