[an error occurred while processing this directive]
BBC News
watch One-Minute World News
Last Updated: Sunday, 27 June, 2004, 21:13 GMT 22:13 UK
African family values
poster in Uganda
A Ugandan poster encouraging abstinence
As the AIDS epidemic rages on, the whole world is trying to learn from one tiny country in east Africa.

Those who oppose the promotion of condoms - including Cardinal Alfonso Lopez Trujillo in the Vatican - point to Uganda as an example of how family values can beat the AIDS pandemic.

Unlike its African neighbours, the proportion of HIV positive people in Uganda has actually declined dramatically over the past decade or so.

There is some dispute about the exact figures, but statistics from the Ugandan government show HIV prevalence has gone from over 20% in some areas to a 6.2% national average in the latest government data.

Cardinal Trujillo says Uganda proves that there's an even better way than condoms to stop the epidemic: to stop people having casual sex at all and encourage young people to remain abstinent until they marry.

In his paper Family Values versus Safe Sex, he argues that Uganda reduced its HIV rate by promoting chastity and encouraging abstinence before marriage and fidelity to one's spouse in the 1990s.

Zero grazing

You cannot just succumb to what is wrong because you want to save your life
Cardinal Emmanuel Wamala, Archbishop of Kampala

The scientific world is divided over how exactly Uganda has beaten back the AIDS epidemic. Some scientists say the Cardinal may have a point on Uganda.

Former WHO epidemiologist Dr Rand Stoneburner told Panorama: "When it comes to interrupting the HIV dynamics at the population level, we just have not seen success from condom promotion."

Christian groups in Uganda stage regular rallies where thousands of young people pledge to remain virgins until they get married. The government also pitches in - one of the largest gatherings, the Uganda Youth Forum, is held annually by the country's First Lady Janet Museveni.

The Ugandan government has encouraged abstinence from sex, and a famous policy of "Zero Grazing," or being faithful to your partner.

The message seems to have gotten through. Surveys show that Ugandans are losing their virginity at a later age and have fewer sexual partners once they start having sex.

A major report by the American aid agency USAID, to which Dr Stoneburner contributed, also concluded that although condoms had a role, "a decrease in multiple sexual partnerships" was the most important factor in Uganda's success against the virus.

However, the Ugandan government also promotes condoms - it gave out 66 million free in 2003.

Easy as ABC

The Ministry of Health says it has an "ABC" approach to prevention - telling the population to be Abstinent or Be faithful, but if not to use a Condom.

"Without the condom I think I would still be having problems with this very sexually active age group, with a very high sexual drive," Sam Okware, the first director of Uganda's pioneering National AIDS Control Programme, told Panorama.

"It's a combination of everything," he said. "It's like saying when you have a car, which are more important, the front wheels or the behind wheels? Or the engine? All the three are equally important - the A, that's the abstinence, the behaviour change as well as the condom."

Because abstinence, faithfulness and condom use were all promoted at the same time, scientists say it's impossible to know for sure which one is the most influential reason that HIV rates fell in Uganda.

Risky sex

Uganda countryside
Abstinence and condom use in the Ugandan countryside went up in the 1990s
Data from Britain's Medical Research Council, which has been closely studying a sample population in rural Uganda since 1989, show that both abstinence and condom use went up in the early 1990s.

The MRC data indicates that while some people chose abstinence or fidelity, those people who did choose to have risky sex anyway started using condoms.

By 1996, 60% of men and 39% of women in the MRC study reported using a condom with their last casual partner.

"We know that people continue to have sexual activity despite the presence of the epidemic," said Dr Nelson Sewankambo, Dean of Makerere University Medical School. "They can only go so far with abstinence."

Problems with condoms

But Dr Sewankambo also pointed out that condoms can fail more often in the developing countries of Africa.

"Condoms might cause a bigger risk in Africa than they have in the West," he said.

He said storage conditions in shipping the condoms from abroad, and storage of them in hot conditions in people's homes, could lead to damage if people weren't careful enough.

Dr Sewankambo said another problem was that condoms weren't readily available in Uganda, especially in rural areas.

At the last count, Uganda averaged 9 condoms a year per sexually active male.

Condom education is also an issue, Dr Sewankambo said. "Without appropriate education, if people get hold of condoms, you may find that they may be misusing them and therefore that could pose a risk to these individuals."

Education

We won't go to heaven if we use condoms. As Catholics we are not allowed to use them
Harriet Nakabugo

He added that in some parts of Africa, "cultural practices that might again put the user at greater risk than one in the West."

He said practices like dry sex - where natural lubrication is deliberately dried out by the female partner - can cause "micro tears" in condoms which increase "the risk of transmission of HIV."

But Dr Sewankambo said he thought these problems could be overcome, and should not dissuade the world from promoting condoms as part of the fight against AIDS.

"If efforts are made to educate people properly when giving them condoms [and] also to store condoms properly, it should be possible for condoms to achieve maximum protection in Africa," he said.

"The risks are significant but that should not deter us from promoting condoms in Africa," he added. "I want to see them promoted and promoted aggressively." Others say the unique secret of Uganda's success was that the government was open about HIV from the mid-1980s onwards - unlike other African governments which denied HIV's existence well into the 1990s.

Open about AIDS

Uganda also instituted regular surveillance of the proportion of HIV positive people in the country, and made that information public to let people know the scale of the problem.

Dr Okware worked on HIV policy from the outset and says Uganda's AIDS prevention approach was multi-sectoral. The government and health agencies worked together with Churches, Mosques, NGOs and local leaders to get their message across.

"All the communities and everybody put HIV/AIDS as an important part of development," said Dr Okware.

In Uganda's countryside, Harriet Nakabugo continued to have unprotected sex with her husband even though she knew he was HIV positive.

"We wont go to heaven if we use condoms," she told Panorama. "As Catholics we are not allowed to use them."

Harriet now believes she is HIV positive.

"She believes that it's wrong," Cardinal Emmanuel Wamala, the Archbishop of Kampala, told Panorama. "You cannot just succumb to what is wrong because you want to save your life." "Maybe that is why you get martyrs," he said.



SEE ALSO:
Can condoms kill?
27 Jun 04 |  Panorama
Condoms at carnival
27 Jun 04 |  Panorama
Condoms: The science
27 Jun 04 |  Panorama
Your comments
27 Jun 04 |  Panorama


RELATED INTERNET LINKS:
The BBC is not responsible for the content of external internet sites

PRODUCTS AND SERVICES

News Front Page | Africa | Americas | Asia-Pacific | Europe | Middle East | South Asia
UK | Business | Entertainment | Science/Nature | Technology | Health
Have Your Say | In Pictures | Week at a Glance | Country Profiles | In Depth | Programmes
Americas Africa Europe Middle East South Asia Asia Pacific