Thanks to Kamilla for writing, “I’m curious as to why the success of Uganda in battling HIV/AIDS isn’t even mentioned?” in response to my post “Meanwhile, What about the Women and Children?” An important question. The Ugandan situation is complex, and I thought I couldn’t do it justice in a short post on the dilemma of Africa’s women and children. But you are right: it should be mentioned.
The initial success of the ABC (Abstain, Be faithful, use Condoms) program in Uganda was dramatic, with the HIV prevalence rate dropping from 15 percent in 1991 to 5 percent in 2000. (See Avert’s lengthy analysis here.) I completely agree with Edward C. Green’s statement that “condoms have not worked as a primary intervention in the population-wide epidemics of Africa” (emphasis mine) – the primary approach must be based on abstinence and fidelity, because the epidemic in Africa spreads through a vast web of “ongoing multiple concurrent sex partnerships.”
However, I also agree with Green’s statement that “all people should have full access to condoms, and condoms should always be a backup strategy for those who will not or cannot remain in a mutually faithful relationship.” This indeed is how condoms were used in Uganda in the nineties: “The number of condoms delivered and promoted by international groups rose from 1.5 million in 1992 to nearly 10 million in 1996.”
Unfortunately, even at its lowest point, the Ugandan AIDS rate was approximately ten times as high as the AIDS rate in the United States. In recent years condom use has decreased (millions of condoms were recalled and burned in 2004, and a severe shortage continued until 2006) as multiple partnering has increased. The Avert report quotes from a Uganda Ministry of Health survey: “The proportion of sexually active Ugandans who reported having had two or more sexual partners in the previous 12 months increased from 2 to 4 percent between 2000?01 and 2004?05 among women, and from 25 to 29 percent among men.” Once again, the AIDS rate in Uganda appears to be on the rise.
Sadly, despite the fact that Ugandan women are far more abstinent and far more faithful than Ugandan men, women are two times as likely to become infected with HIV. Yes to everyone who believes that abstinence and fidelity are the most important factors in reducing the spread of HIV. And yes to condoms as a necessary backup measure among people who will not, or whose partners will not, be abstinent and faithful.
