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Last Updated: Tuesday, 2 December, 2003, 15:47 GMT
Uganda turns back the Aids tide
By Will Ross
BBC, Kampala

Uganda is one of the few nations to have turned a burgeoning Aids crisis into a relative success story.

Florence, Ugandan Aids patient
Florence Mohoro has lived for 11 years with HIV
When Florence Mohoro was diagnosed with HIV in the early 1990s, HIV prevalence in Uganda was well above 10% and reported as up to 30% in some urban areas.

Doctors gave her two years to live. Eleven years later, living a full life on anti-HIV drugs, she looks back and laughs at the prognosis.

Similarly for the country, although the government says Aids has killed close to a million people and orphaned nearly two million children, the worst predictions have not come to pass.

[Aids is] not hard to prevent - if there is a snake in a hole, why do you put your finger in the hole?
President Yoweri Museveni
A massive government education programme from the early 1990s made Uganda the first country in sub-Saharan Africa to reverse its own Aids epidemic.

Florence remembers well the dull-toned drum beats that preceded every news bulletin, followed by the message "Aids kills".

"I was definitely scared, but somehow death seemed to be remote - for somebody else but not me," she recalls.

'Embarrassing disease'

Six years earlier, the then Minister of Health, Doctor Ruhakana Rugunda, had faced harsh criticism from fellow African colleagues when he announced at the World Health Assembly that Uganda faced HIV and Aids.

"They told me I was portraying Uganda and Africa in a bad light by admitting to such an embarrassing disease," he remembers.


The statistics show that this early openness paid off. The Health Ministry now estimates that 6.2% of the population carry the virus.

While doubts have been raised over the accuracy of these figures, there has clearly been a fall in HIV prevalence since the early 1990s and this is evident in localised changes.

For example, figures recorded at an antenatal clinic in central Kampala show a drop from 24.5% being HIV positive in 1989 to 8.5% by 2002.

President Yoweri Museveni made it a government policy to be open about HIV and Aids. He insisted that the topic was included in sex education in schools.

Eroding stigma

Professor Francis Omaswa, the director of health services at Uganda's Health Ministry, is convinced that the government's warning broadcasts worked.

"I have heard many personal testimonies of men who were ready to have sex and then they heard the radio and put their trousers back on," he says.

Ugandan Aids poster
Uganda has been campaigning on Aids since the late 1980s
But it was only when the campaigns began to focus on living positively with HIV and Aids that they began to erode stigma and denial.

Ugandan musician Philly Lutaaya greatly contributed by being one of the first to announce he was HIV-positive.

In 1987, the National Aids Control Programme was launched. In the same year, the widely-respected Aids Support Organisation, known as TASO, was founded by a group of HIV-positive volunteers.

Easy as ABC

The Ugandan approach has been dubbed the "ABC" strategy, with the emphasis firstly on abstinence, then on being faithful and thirdly on condoms.

Ugandan street vendor selling condoms

At the Ministry of Health, Mr Omaswa is quick to claim that condoms have not been the main reason for the drop in HIV rates:

"Condoms have a place in the control of HIV/Aids. But more importantly, the sexual behaviour in Uganda has changed. There is more responsible sex - full stop," he states.

But young people are not so sure. The organisation Straight Talk makes radio programmes and a newspaper for distribution in schools.

At Kitante Hill secondary school, Samuel Nangira, a member of a club set up by Straight Talk, says that few teenagers are abstaining from sex - they prefer to rely on condoms.

Vital drugs

While progress has been made in raising awareness, few people living with HIV and Aids are able to access life-prolonging antiretroviral drugs, even though prices have fallen.

Currently the most common drug combination costs $27 a month.

ANTIRETROVIRAL DRUGS

An estimated 15,000 Ugandans are taking the drugs, but over 150,000 desperately need them.

The Joint Clinical Research Centre is the main supplier of these drugs. Its director, Doctor Peter Mugenyi, is concerned that without an effective information campaign, the drugs will not be used properly and will become less effective as the virus mutates.

"People need to know that these drugs are delicate and if not used correctly, resistance will occur. That danger is real," he warned.

A task force from the Ministry of Health has been addressing this very question, but many health professionals say the country is not well prepared for antiretroviral drugs.

Meanwhile despite being told she only had two years to live Florence Mahoro works energetically for the Aids Information Centre. Her drugs are paid for by a sponsor.

Visit any hospital and it is clear Uganda still faces a mountainous task. An ongoing war in the country is hindering progress.

HIV patients are calling for more support, better access to anti-viral treatment and help with costs for other drugs.

But President Museveni has always maintained that the battle can be won.

In his own words: "[Aids is] not hard to prevent because we know where it comes from. If there is a snake in a hole, why do you put your finger in the hole?"

If you have any comments to make in response to this article, you can send them to us using the form below. If you would like to take part in one of our programmes on HIV/Aids, please include your phone number. Your personal details will not appear online.


Your comments:

What a shame that the country I live in, South Africa, didn't admit earlier than we were facing an Aids epidemic. The government lived in denial. It's now too little, too late, as so many are already infected. I admire Uganda.
Lyn van Haght, South Africa

Openness can save millions of lives across the world particularly in Africa
Ogingo Peter, Kenya

A time ago I attended the funeral of my cousin (who was married to my sister-in-law). My then father-in-law disclosed that his son-in-law had died of HIV complications.

He then dared any brother of the deceased to inherit the widow if they were man enough! There was an uproar and name calling against my father-in-law for his outspokenness for lowering the dignity of my cousin's family. I was shocked! Not only for his bravery at such a function, but for the lives of the wife inheritors that he saved through his statement and the agony the families of the inheritors would have gone through had they inherited my sister-in-law.

Openness can save millions of lives across the world particularly in Africa where some of these outdated practices as wife inheritance are still rampant. Pure ignorance.
Ogingo Peter, Kenya

I'm impressed by how the Ugandan government has taken charge of this epidemic. It goes to show that African countries too can handle crises that arise within their borders, without relying so much on the western world for help.

It's time other African countries took Aids seriously. We need to start teaching about Aids in schools, as early as primary schools.

Aids has been here long enough, it's time to eradicate the stigma against people with Aids and work on preventing this disease. Most Africans cannot afford anti-retroviral drugs, but changing our sexual behaviours is affordable.
Cynthia Adhiambo, USA

The world deserves to know of the valiant struggle that went on there to educate people and to erase the stigma of Aids
Bonnie Shullenberger, USA

My husband and I were in Uganda from 1992-4. The world deserves to know of the valiant struggle that went on there to educate people and to erase the stigma of Aids. It was not perfect; nothing is. But from the teenage girls who organized Behaviour Change clubs at their schools to church and civil leaders who broke silence, we watched a nation gradually learn to battle Aids together. We hope it continues, and that the model can be transported.
Bonnie Shullenberger, USA

Museveni's words sound sweet to hear but they are not representative of an average Ugandan. While the middle class Ugandan can be blamed for pushing his/her fingers into a snake's hole, reservations should be there for the lowest class.

Untold number of innocent girls trapped in Uganda's infamous battle lines have not spoken. Theirs is a forced death sentence with no appeal by commanders of warring factions. They are forced in sex to save their families from victimisation and starvation.

In the urban areas, the middle class infected have not left any stone unturned among the poor unsuspecting youths.

In summary, the threads of HIV/Aids in Uganda will not cut as long as war, poverty and unemployment continue dogging the low class.
Enyaku Aleku, Uganda

I lived in Uganda for about eight years before moving to Canada. During this time I got an excellent education about sexually transmitted diseases with Aids at the centre of it all. In primary school we were shown cartoon strips on how Aids was bad. We were told stories that scared the life out of us.

I am glad that Uganda took the effort to educate its people and hope other countries follow suite. Countries should be completely open and take Aids seriously, the only way to stop the epidemic.
N Dhruve, Canada

No one is talking. It is killing people daily, you see them everywhere, yet no one is doing anything about it
Iheoma Obibi, Nigeria

I watched the 46664 concert on SABC Africa and wondered how we in Nigeria could get to the position of Uganda. We have a pandemic on our hands. No one is talking. It is killing people daily, you see them everywhere, yet no one is doing anything about it. I feel like I am talking hot air. I have started with my family members which has been very difficult.

Uganda is an inspiration to us all about what is possible if we are honest. I would wish for our government to emulate what the government of Uganda have done. There must be practices that can be transferred. In all, I just wish more could be done here in Nigeria.
Iheoma Obibi, Nigeria

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