KAMPALA: Beatrice Were says she did just what her government recommended – shunned sex until her marriage and stayed faithful to her husband.
What she did not realize is that he was unfaithful. Soon after their first child was born, he caught the AIDS virus and unwittingly infected her.
The question of why Ugandans like her husband did not use a condom is at the heart of a dispute between some health activists and the US government.
The activists, as well as some Ugandan officials, accuse the United States of blunting the condom message in favor of abstinence, while the Americans say they are victims of misinformation and have actually increased nearly tenfold the number of condoms they supply to this African nation of 26 million.
Moreover, abstinence is an option promoted not just by faith-based US groups but by many Ugandan charities, including one headed by the conservative Christian wife of President Yoweri Museveni.
The debate has unfolded in a country that was once among Africas worst AIDS victims, with a million deaths and an estimated 900.000 additional infections.
Uganda is also the pioneer of a groundbreaking strategy credited with cutting HIV prevalence by more than half since 1992 to about 7 percent. The multipronged approach, known as A, B, C, calls for abstinence until marriage, being faithful to ones partner, and correct condom use.
Billboards urging condom use have disappeared from the Ugandan capital, Kampala. In their place are posters, some funded by the US government, urging youth to delay sex until marriage. The Ugandan office of Washington-based Population Services International, a leading supplier of free and subsidized condoms, says it was ordered to take down posters and pull radio ads in Uganda in 2004.
Its deputy director, Dr. Susan Mukasa, said the portion of the groups US funding that is spent on prevention was not renewed and its funding from PEPFAR, the U.S. Presidents Emergency Plan for AIDS Relief, dropped from 600.000 to 100.000 US dollar.
– We got a call from the PEPFAR people and were told what we were doing was unacceptable. We also got a lot of pressure from faith-based groups in Uganda who wanted the condom message removed from the general public, said Mukasa.
PEPFAR, a 15 billion US dollar package to combat AIDS in the worlds 15 worst-hit countries, won praise when Bush announced it in 2003. But Dr. Sam Okware, a senior Health Ministry official and architect of the ABC plan that has become the model across Africa, says PEPFAR had initially skewed the message away from condoms.
– PEPFAR really shifted the emphasis to A and B just because of the amounts of money being put into these programs, said Okware.
He said the Ugandan government has redressed the balance by using funds from other sources to promote condoms, including the World Bank. But an official with the government-appointed Uganda AIDS Commission disputed that, saying abstinence and fidelity programs still dominate.
Dr. Mark Dybul, the US deputy global AIDS coordinator in Washington said government policy is to support all three components of the ABC plan.
Dybul doubts anyone would have called PSIs work “unacceptable.” But he said US officials want to move away from simply mass marketing condoms and support more door-to-door and peer education plans.
Last year, the US government spent 9,7 million dollar on promoting abstinence and fidelity in Uganda, compared with 6,5 million on condoms and related activities, while the number of US-supplied condoms has surged from 7 million to 47 million in the last five years, Dybul said.
– Tough to argue we are pushing away from condoms in Uganda with numbers like that, Dybul said, adding: There is so much misinformation about what our policies and approach are that I would not be surprised it is having an impact on people in the field.”
President Museveni, who once championed condoms, now considers them more appropriate for people considered at high risk of infection, such as prostitutes and soldiers. Special clubs and rallies encourage teens to sign virginity pledges, and a legislator has promised university scholarships for top students who keep the promise.
First lady Janet Musevenis National Youth Forum, which received 180.000 dollar from the US emergency plan last year to help 12- to 25-year-olds protect themselves from AIDS, says it is willing to answer the publics questions about condoms but does not teach how to use them.
– In our traditional society, girls used to marry when they were virgins. Why has this changed? asked Margaret Kiwanuka, the forums national coordinator. – Abstinence is 100 percent effective. That is our message, added she.
The Anglican Church, which received 86.620 dollar from the plan last year, helps educate sexually active adults about condoms but not under-18s. – Why give an alternative and have them take a risk? said Rev. Sam Lawrence Ruteikara, who heads the churchs AIDS program.
But some activists not affiliated with churches worry that the prevention message is becoming blurred, jeopardizing hard-won gains.
HIV prevalence crept up to 7,1 percent in 2004-2005, after stagnating at around 6 percent the preceding three years, according to government figures.
Kilde: The Push Journal
