Rebecca Schleifer, a researcher with HRW says that censorship of information about condoms in government-funded programs, myths about condoms spread by religious leaders, and restrictions on condoms hamper the fight against the AIDS pandemic.

Uganda’s Presidential Advisor on HIV/AIDS, Kintu Musoke however says the Uganda government is still pursuing the ABC policy, only bringing abstinence and be faithful on the limelight which he says had been cast in the shadows in favour of promoting condom use. “What we are emphasising is that behavioural change is what we need most to fight HIV/AIDS,” Musoke said in an interview.

<“The behavioral change remains low relative to the high levels of awareness,” adds Dr. Alex Opio of Uganda’s Aids Control Program.

Although government insists on behavioral change as the key factor in HIV prevention, the UAC report shows that only 50-55% of young men and women aged 15-19 use condoms during sex with non-regular partners.

This means that over 40% of the youth aged 15-19 have unprotected sex with non-regular partners, and are at high risk of contracting HIV, the virus that causes AIDS.

Apac Women's Group against HIV/AIDS

Worse still, the survey findings reveal that much as all the districts in the country now have some level of Prevention of Mother To Child Transmission (PMTCT) services, almost half (22) of the districts have disappointing coverage ranging from 25-50%.

So, what is the way forward?

All said, many HIV/AIDS activists still believe ABC as appropriate and effective approach for prevention of transmission of HIV, even when they disagree on which of the components is most effective.

Even the newly advanced SAVE approach, has many ingredients of ABC much as the proponents would wish us to believe it is an independent approach. They have only extended it to areas of care and support, which are necessary in the HIV/AIDS fight.

This may explain why the UTTA report recommends the re-launch of ABC model as ABC plus (ABC+) as a motherboard of future HIV/AIDS interventions to comprehensively accommodate the existing and emerging challenges in the response to the HIV/AIDS pandemic.

UTTA says that ABC should be promoted as one entity, putting emphasis on ABC in the policy strategies and practice as well as addressing the challenges associated with each of the three components. It says that A, B and C should be harmonized through specific policy framework as each of the components re-enforces the effectiveness of the other.

“Where as Abstinence is very pertinent to the youth today, especially the girl child, Faithfulness is the best option for married couples in those long-term relationships. C should be targeted for high risk groups, should be promoted among those already infected especially in care settings and is key in discordant relationships,” the report notes.

But all these can work only if there is enhanced and sustained political commitment and leadership on ABC. “Leaders at all levels should be involved in the dialogue, harmonize their positions and provide visible leadership for ABC model. Identify and address human, institutional, societal, cultural and environmental factors and vulnerabilities that predispose certain categories of people to HIV infection,” the report recommends.

This together with bridging the knowledge gaps to raise risk perception, and reducing on confusing and conflicting messages on how to better fight HIV/AIDS will provide a more winning approach against the pandemic, the report says.

Beyond Prevention to HIV/AIDS Treatment

Yet beyond the prevention issues, it is also apparent that much of the country’s success against HIV/AIDS will depend on how those currently infected are handled. The Executive director of Aids Information Center, Dr. Raymond Byaruhanga, said Uganda faces a challenge of the increasing demand for HIV/ AIDS services due to the increasing number of infections.

The country in 2004 adopted a policy of providing free anti retroviral drugs (ARVS), the life prolonging medicines for HIV positive people. But UTTA says only 135,000 out of more than 300,000 people infected with HIV who urgently need the medicines are able to access them.

This has been blamed on limited government funding to the HIV/AIDS sector. According to the Ministry of Health, more than 80 percent of the country’s HIV funding is from foreign sources; the two leading donors being the Global Fund to fight AIDS, Tuberculosis and Malaria and the US President’s Emergency Plan for AIDS Relief.

Uganda’s Minister of Health, Dr. Stephen Malinga says while the government remains committed to its comprehensive plan to fight HIV/AIDS and solve all arising challenges, the country does not have enough money to invest in anti HIV programs. “We have limited resources and there are just so many priorities as a country,” he says.

Dr. Malinga says the Government, with the support of various development partners (DPs), CSOs and other stakeholders is implementing various programs including re-energizing HIV&AIDS control activities across the country, scaling up Anti Retroviral Therapy, HIV Counseling and Testing and PMTC.

The Uganda HIV Prevention Roadmap specifically highlights the following:

• Prevention of the sexual transmission of HIV,
• Prevention of mother-to-child transmission of HIV,
• Promotion of greater access to HIV counseling and testing (HCT) while promoting principles of confidentiality and consent,
• Integration of HIV prevention, care and support services with other health care and social services,
• Integration of prevention into care and support programs for PHAs;
• Prevention and treatment of STIs,
• Focusing prevention on vulnerable and higher risk groups including young people,
• Advocating for protection of rights of women, girls, children, PHAs, IDPs and other minority groups within existing policy and legal frameworks,
• Preparation for access to and use of promising new technologies for HIV prevention
• Consideration of appropriate and safe response to new evidence such as circumcision, HSV2 suppression therapy, microbicides and vaccines,
• Ensuring blood safety and reduce HIV transmission in the health care and other settings.

Related links

Assessing the Macro economic impact of HIV/AIDS in Uganda- a research done by Uganda

Ministry of Finance Planning and Economic Development and United Nations Development Programm

HIV/AIDS in Uganda– a comprehensive analysis of the HIV/AIDS situation in Uganda by avert.org

UNAIDS 2010 report on the global AIDS pandemic

By Gerald Businge

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