AIDS – The New Crisis

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After such a successful reduction of the AIDS prevalence rate for the best part of a decade, ridding the country of the disease completely was always going to be a harder challenge to overcome. So it has proved. Uganda’s HIV/AIDS rate has stabilised between 6 and 7% for most of the past decade and most studies now point to a slight increase. As our counselling tutor pointed out in his introduction seemingly small upward trends, such as the estimated rise from 6.4% to 6.7% between 2005 and 2008 have a huge human impact as it translates to an extra 45,000 with the virus.

In part, the rise can be explained simply by the fact that more people are staying alive. The rollout of ARVs in 2004 has kept many people alive who would have otherwise reduced the headline prevalence rate. In 2002, over 75,000 people died of HIV/AIDS while by 2009 it was ‘only’ 64,000.

This cannot quite explain it all. Much of the criticism of international NGOs and the ‘liberal’ west has been of the influence of the First Lady, Janet Museveni, and religious institutions in influencing the government to promote abstinence and faithfulness over condoms. The menacing shadow of right-wing Christians in the US under the auspicion of PEPFAR using their financial might to pressure them makes it even more distasteful. This is right, to a degree. While I have barely seen Mrs Museveni in the public arena, it is hard to go through a day without hearing or seeing an advert telling people to, “get off the sexual network” and abstain or to use the rather-creepy sounding Love Wheel, where you and your loved one can find new activities, like watching soap operas, to keep the spark alive. The A and B of the ABC strategy are now clearly being prioritised, if they weren’t before.

This, however, isn’t quite the whole story. Before I came here I was convinced by the commonly-held view in most of the West that condom use was the answer to nearly all the unwanted consequences of sex. My experiences thus far, however, have led me to rethink to a very small degree. I have heard umpteen times the fact that condoms are 98% safe but having it repeated when I was thinking of that 2% risk in terms of HIV/AIDS made me think that it might not be a risk that I would want to take if I was having sex with an infected person on a regular basis.

More significantly, is the estimation (source – counselling tutor but I hope he got it from more than just a personal spot check) that only 5% of Ugandans use condoms correctly and consistently. Apparently misuse reduces condoms effectiveness to 89% within Uganda.

Aid agencies and donors in their well-intentioned efforts to continue the fight against HIV/AIDS provide condoms to small community-based organisations like my own or to the general public free of charge. Few questions are asked; the grassroots organisations use them as one of the few resources they have and people take them away in the box load but at no stage have I ever seen a demonstration on how to use them (apart from in the classroom at our counselling class).

Oddly, the places where condom use is estimated to be the lowest in Uganda, Karmajong and the West Nile, are areas where the prevalence rate is well below the national average. I do still realise that the correct use of condoms would reduce the HIV rate. I merely now think twice about an issue that I thought was fairly clear cut.

Of greater significance, perhaps, is the shying away of talking of sex as a cause of HIV/AIDS. The one school visit I have done with UYWEFA, from watching TASO in action in schools and debates in our class, people correctly talk of the many different ways of transmitting HIV. There is not, however, any emphasis on which are the main ways of getting the virus. It would be easy to think as a student walking away from workshops that you had as much chance catching HIV from using a knife without cleaning it first as having unprotected sex. In fact, modes of transmission other than sex and from mother to child make up 1%. It is almost as too much knowledge has hindered progress and while knowing that if you swallow 5 litres of saliva you can catch the virus maybe good trivia I'm not sure presenting it to an unsensitised audience is particularly helpful.

How to start reducing the HIV/AIDS rate again? I wouldn’t have a clue but the loose consensus between government, NGOs, civil society and religious institutions that was apparently around during the 90s seems to have been lost. Even within organisations there is disparity in strategy, the Ministry of Education forbids talk of condoms in schools, while the Ministry of Health will give them out like sweets at community events. PEPFAR will not promote the use of condoms in its activities but condoms ‘from the American people’ (USAID) are everywhere.

Particularly damaging is the divide between more traditional factions within the country that do not want to promote sex education and want to encourage abstinence and the liberals and internationals that want to promote the use of condoms and educate children about sex from a young age western-style. Good sexual education around the country may have a positive impact but it is also true that for many young people ignorance and fear of sex prevents them from getting infected. Any rollout of sexual education will have to be a long-term strategy as at the moment the resistance due to religion, cultural and fear of change.

In the short-term a compromise has to be reached for any progress to be made, practical measures such as an increase in the testing of couples (married and not married) and pregnant women would allow different groups to rally around behind a cause again. As it is, the little change is having a big impact.

We have now finished our course so this will be the last of my ramblings on the subject. It was definitely worth doing, even if it was a bit of an endurance at times, and provided a good beginners guide to a subject it would be easy to spend a lifetime studying.

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