US is accused of jeopardising HIV prevention in Uganda

US accused of jeopardising HIV prevention in Uganda

New Haven, Connecticut

Ozge Tuncalp

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.

Mark Dybul, Deputy US Global AIDS Coordinator, denied the accusations, saying: "The statements that I have heard are completely untrue and completely mischaracterise effective prevention programmes." He rejected Mr Lewis's criticism, claiming that the current administration supported condom use as part of a balanced programme that included prevention.

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. The plan was announced in President Bush’s state of the union address in January 2003 (BMJ 2003;326:299) and was set up after the 2003 United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act.

It aims to distribute $15bn over five years for bilateral and multilateral programmes, concentrating on 15 countries with a high prevalence of HIV and AIDS, including Uganda. Although the 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. Free condoms provided by healthcare clinics all over the country (often the only source of condoms in remote areas) seem to have disappeared. Although warehouses are filled with Engabu condoms, a brand made in Germany and China, the condoms are no longer being distributed.

A year ago, Ugandans began to complain that the Engabu condoms smelled bad. Uganda sent a batch to Sweden for testing and initially they were found to have holes. Further widespread testing found that the condoms were actually fine, but by then the damage was done. Uganda instituted a requirement that condoms undergo new testing when they arrive in Uganda, but all condom distribution was stopped for months while the testing regime was set up.

The acting Director General of Health Services, Dr Sam Zaramba, said that the batch of Engabu that failed the tests had been destroyed and further tests on batches of Engabu condoms in storage had shown they were perfectly fit for use. "Only one batch of the Engabu condoms was found with the defects. These have now been destroyed and we have carried out numerous tests to ensure that the condoms we have in stock are free of any defect," he said. (Source: www.allafrica.com)

The government is now trying to negotiate a deal for the rebranding of those 30 million condoms sitting in the warehouses.

Meanwhile, the results of a recent survey by the Ugandan Ministry of Health indicate that the rate of new HIV infections has risen to 7% for men and 9% for women from a rate of 4.1% in 2003, cited by the UN and the Ugandan government.

The latest government announcement says, however, that Uganda is planning to import 154 million condoms in the next two months.

Stephen Lewis’ remarks can be found at www.genderhealth.org/uganda.php