‘ABC’ prevention is becoming ‘AB’ in Uganda, thanks to US influence against condom use, says report

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The US-funded strategy of ‘ABC’ - Abstinence, Be Faithful, use Condoms - is in effect an abstinence- and pro-marriage monogamy-only strategy in Uganda, according to a new 80 page report, The Less They Know, the Better: Abstinence-Only HIV/AIDS Programs in Uganda, released on Wednesday by Human Rights Watch.

The report documents how the recent removal of crucial information about HIV prevention from school curricula – including information about condoms, safer sex and the risks of HIV in marriage - together with misinformation regarding the effectiveness of condoms and an anti-condom campaign spearheaded by Uganda’s President Yoweri Museveni and his wife, First Lady Janet Museveni, all threaten to unleash a new wave of HIV infection not just in Uganda, but in other resource-limited countries similarly funded by the President Bush’s global AIDS plan, who look to Uganda as a model.

“The effect of Uganda’s new direction in HIV prevention is thus to replace existing, sound public health strategies with unproven and potentially life-threatening messages,” says the report, “impeding the realisation of the human right to information, to the highest attainable standard of health, and to life.”

Glossary

retrovirus

A type of virus that uses of RNA as its genetic material. After infecting a cell, a retrovirus uses an enzyme called reverse transcriptase to convert its RNA into DNA (the hereditary material in humans). The retrovirus then integrates its viral DNA into the DNA of the host cell, which allows the retrovirus to replicate. HIV is a retrovirus. 

safer sex

Sex in which the risk of HIV and STI transmission is reduced or is minimal. Describing this as ‘safer’ rather than ‘safe’ sex reflects the fact that some safer sex practices do not completely eliminate transmission risks. In the past, ‘safer sex’ primarily referred to the use of condoms during penetrative sex, as well as being sexual in non-penetrative ways. Modern definitions should also include the use of PrEP and the HIV-positive partner having an undetectable viral load. However, some people do continue to use the term as a synonym for condom use.

The report highlights that Uganda faces a national condom shortage due to government restrictions on condom imports implemented late last year. “Rather than take steps to address the shortage," says the report, based on in-depth research by Human Rights Watch, "Uganda’s minister of state for primary health care stated, ‘As a ministry, we have realised that abstinence and being faithful to one’s partner are the only sure ways to curb AIDS. From next year, the ministry is going to be less involved in condom importation but more involved in awareness campaigns; abstinence and behaviour change’.”

In addition, a draft 'Abstinence and Being Faithful (AB)' policy released in November 2004 by the Uganda AIDS Commission cautions that providing information about condoms alongside abstinence can be “confusing” to youth. Teachers are quoted in the report as saying that they have been instructed by US-funded advisers not to discuss condoms in schools because the new policy is “abstinence only.”

“Uganda is gradually removing condoms from its HIV/AIDS strategy, and the consequences could be fatal,” said Tony Tate, a researcher with Human Rights Watch’s Children’s Rights Division and the report’s co-author. “Delaying sex is surely a healthy choice for young Ugandans, but youth have a right to know that there are other effective means of HIV prevention.”

The report points out that some experts credit the ‘ABC’ strategy with helping to reduce HIV prevalence in Uganda from about 15% in the early 1990s, to around 6% today, although a recent study presented at the Twelfth Annual Retrovirus Conference in Boston last February, found that it was mortality, and not behaviour change, that was responsible for 80% of this reduced prevalence in one Ugandan district.

Although the report gives credit to Uganda for its attempts to deal with HIV prevention, it strongly suggests that the country falls short in its campaigns since “as a perceived global leader in HIV prevention, Uganda is accountable to evidence and best practices in HIV prevention. The country’s high-profile U-turn toward unproven HIV prevention strategies for young people has, at this writing, already begun to resonate throughout other parts of Africa. Its complicity in the rewriting of history around its HIV prevention ‘success’ could have implications on HIV prevention programs for years to come.

"Ultimately," the report concludes, "it is not just Ugandans who will pay the price for the country’s back-steps in HIV prevention. It is the entire effort against the global AIDS pandemic.”

The Less They Know, the Better: Abstinence-Only HIV/AIDS Programs in Uganda, is available in full at the Human Rights Watch website.