Africa Matters is a blog that follows the news and offers analysis of African affairs. Our aim is to delve deeper into the issues of African politics and development. We don’t presume to be experts, and we don’t presume to have all the answers—we are just trying to ask the right questions.

Thursday, March 29

The ebb and flow of aids in Uganda

A fascinating article by Craig Timberg in today’s Washington Post traces the history of Uganda’s fight against HIV/AIDS and laments what seems to be a downturn, of late, in the exemplary success of its programs. Uganda has been unique among African countries in its efforts to combat the spread of this devastating virus—not just for the remarkable decline in infection rates, but also, Timberg points out, for the methods by which they were reduced.

Condom distribution programs and sexual education receive much of the credit for Uganda’s accomplishments in this realm, but Timberg asserts that the real drop came when President Museveni was still resistant to prophylaxis and before condoms were readily available in the country.

Instead, Uganda’s early- to mid-1990s turnaround was premised on an uncommon and controversial approach—unlike other countries, which have “followed a diffuse palette of other remedies pushed by Western donors—condom promotion, abstinence training, HIV testing, drug treatment and stigma reduction,” Uganda employed simply “fear and a relentless focus on sexual fidelity.”

Above all, the image of Philly Lutaaya, a Ugandan-born Afro-pop superstar, had particular resonance with Ugandans—Lutaaya died of AIDS at the age of 38 but, before his death, sang and spoke about the horrors of the disease, the dangers of promiscuity, and the importance of fidelity.

At his final show, “This symbol of swaggering virility had grown gaunt, with splotchy skin and the fine, sparse hair of a baby. ... Between songs, he warned the stunned crowd that having several sex partners was a sure way to die in the age of AIDS, echoing pleas also made by political and religious leaders of the time.”

Timberg points to a study by Cambridge scientists Rand L. Stoneburner and Daniel Low-Beer, which finds that the main decline in infections occurred from 1990 to 1994 and was a result primarily of “the decision by Ugandans to have fewer casual sex partners.”

In recent years, HIV/AIDS prevention has been a topic of heated debate, especially since the inception of President Bush’s 2003 $15 billion anti-AIDS program (PEPFAR), which pushes for an “ABC” strategy—abstain, be faithful, and condomize—with special emphasis on abstinence. The discourse has become increasingly partisan and ideological, with the president and other social conservatives prioritizing abstinence—and even urging “abstinence-only” education—while detractors stress the importance of condoms.

But Timberg holds that, in this struggle between A and C, the B has become largely forgotten, even in Uganda. By the time the effectiveness of Uganda’s initial approach became clear, “the initiative had been overtaken by big-budget, bureaucratic programs that resembled those in most African countries. Persuading Ugandans to stay faithful to their partners was no longer the focus.”

Timberg observes: “Nearly 18 years after Lutaaya's dramatic crusade, billboards warning against the dangers of reckless sex are hard to find in today's Kampala, the graceful, hilly capital. Far more common are photocopied fliers brazenly saying ‘Get a Lover’ and listing a cellphone number.”

There is no doubt that methods for curbing the spread of HIV remain hotly disputed and controversial. This article should highlight, though, that just as dangerous as ideologically driven, idiosyncratic pressure for abstinence-only education is an equally ideological backlash that dumbs down the debate and masks data on what actually works and what doesn't. Of course, any strategy must be appropriate in the context in which it is implemented, and one cannot jump to generalized conclusions based on what seems to have worked in Uganda. Nevertheless, the truth is that Uganda is one of only a few countries that have been able to make a meaningful dent in the spread of AIDS, so we ought to look closely at what approaches, in reality, have been effective there.