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AFRO-NETS> Former WHO Official Touts Ugandan Focus On Abstinence, Fidelity
- Subject: AFRO-NETS> Former WHO Official Touts Ugandan Focus On Abstinence, Fidelity
- From: Dieter Neuvians MD <email@example.com>
- Date: Thu, 13 Mar 2003 16:29:27 -0500 (EST)
Former WHO Official Touts Ugandan Focus On Abstinence, Fidelity
A former World Health Organization researcher has said Uganda's "ABC"
strategy to combat HIV/AIDS -- Abstinence, Be faithful, use Condoms,
in that order -- could cut HIV infections by 80 percent if expanded
across Africa, according to a feature in today's Washington Times.
International aid workers have rebuffed the policy, calling it a
cover for a right-wing agenda.
Since Uganda launched the strategy in 1986, HIV/AIDS rates there have
steadily declined, while infection rates in much of the rest of Af-
rica have skyrocketed. Under the program, HIV prevalence among preg-
nant women -- a common yardstick for assessing HIV transmission in a
population -- dropped in Uganda from 21 percent in 1991 to 6 percent
Some experts said the key to the program's success has been in chang-
ing Ugandans' sexual behavior by focusing on sexual fidelity, some-
thing international aid workers reportedly were doubtful about. Ac-
cording to epidemiological data, the focus on faithfulness may be the
most important ingredient in the overall program's success.
"Women had to take responsibility for their own lives," said Sophia
Mukasa Monico, a Ugandan who is a senior AIDS program officer for the
Global Health Council. "Wives told their husbands to be faithful, use
a condom, even in marriage, or there would be no sex. Many women in
Uganda had celibate marriages or moved out on their own," she said,
adding that today, 60 percent of Ugandan women live on their own or
The number of men reporting two or more sexual partners plummeted
from more than 70 percent in 1989 to 15-20 percent in 1995. Among
women, that figure dropped from 18 percent in 1989 to 2.5 percent
According to the Washington Times, Ugandan President Yoweri Museveni
began the program after almost one-third of his top military officers
tested positive for the virus during a trip to Cuba in 1986. Later
that year, Cuban President Fidel Castro reportedly took Museveni
aside and told him, "Brother, you've got a problem."
"Uganda mobilized as if it were World War III," said Elaine Murphy, a
global health specialist at George Washington University. "They did
this without donor money, on their own."
At the time, "the AIDS establishment laughed at him. ... But Museveni
was right," said Norman Hearst, an epidemiologist at the University
of California, San Francisco. "I've had people tell me that the only
reason they were successful in Uganda is that there were no European
or American experts there."
A more common international approach that relies heavily on condom
distribution has been deemed largely a failure by some. "There really
is not any clear evidence that condom promotion by itself has been
able to roll back the AIDS epidemic in any country where there is
widespread transmission," Hearst said.
"The historical approach to HIV has been little A, little B and big
C. The public health community at large did not believe in absti-
nence, but Africans were far ahead of the worldwide public health
community on this," said Anne Peterson, a U.S. Agency for Interna-
tional Development global HIV/AIDS official. "The core of Uganda's
success story is big A, big B and little C."
But U.S. HIV/AIDS workers have reportedly been reluctant to implement
ABC-style programs, which have been endorsed by President George W.
Bush and many faith-based organizations, for fear ABC is a cover for
an "abstinence-only" policy.
Hearst said that "those who oppose ABC are just as religious in their
beliefs as missionaries, and no more constructive. They are willing
to let Africans die rather than embrace something that goes against
their way of life."
The Washington Times reports that ABC may be gaining more acceptance.
ABC programs launched in Senegal and Zambia are reportedly showing
positive results, and AID in December embraced ABC. "Thinking people
have to ask the question, 'What works? What saves lives?'" said Mur-
phy (Tom Carter, Washington Times, March 13).
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