The United Nations' special envoy for HIV and AIDS in Africa, Stephen Lewis, has accused the United States of bowing to pressure from religious groups and promoting abstinence only programmes in Uganda to prevent HIV infection.

Uganda has been one of Africa's success stories in terms of HIV prevention. The rate of transmission of HIV declined from 15% a year in 1991 to 5% in 2001. One of the generally accepted reasons for the success has been President Yoweri Museveni's acknowledgment of the epidemic as a serious problem. Unlike many other African leaders President Museveni has called for a nationwide fight against HIV and AIDS and has allowed non-governmental organisations to embrace the “ABC” approach (abstinence, be faithful, condoms) to reduce infection rates.

However, Mr Lewis's remarks, made at a press conference at the end of August, have raised concerns about recent changes to prevention programmes in Uganda.

Mr Lewis said that the US government had been “acting under the influence of the religious right in the US by running the multibillion dollar campaign emphasising abstinence.” He also raised concerns about the reduced availability of condoms in the country and a tripling in their price.

Advertisements promoting abstinence only behaviour to prevent HIV infection are filling billboards across the country

Credit: PERS-ANDERS PETTERSSON/GETTY IMAGES

Mark Dybul, deputy US global AIDS coordinator, denied the accusations. “The statements that I have heard are completely untrue and completely mis-characterise effective prevention programmes,” he said.

African countries such as Uganda rely heavily on foreign aid to support their nationwide projects, including their HIV and AIDS prevention programmes. Over the past two years $200m (£113m; €166m) from the US president's emergency plan for AIDS relief was channelled to Uganda to support the prevention programmes.

Although the president's programme was widely welcomed by charities and aid organisations, it has also been a cause of debate for its explicit support of abstinence only prevention projects (BMJ 2004;329: 192).

The Museveni government denies any change in policy. However, a recently introduced regulation forbids any national or international non-governmental organisation distributing condoms in high schools during HIV and AIDS education classes, in which hundreds of young adults, many of whom are sexually active, can be reached.

Advertisements promoting abstinence only behaviour are filling billboards across the country. Moves such as “calling for a census of virgins in the country,” led by the president's wife, an evangelical Christian and opponent of condom use, are also abundant.