“I am here because I am worried,” Clinton said Friday during a tour of a health center near the Ugandan capital, Kampala, that treats women with HIV and AIDS.
“In recent years, the focus on prevention has faded, and new infections are on the rise again,” she said. “Uganda is now the only country in sub-Saharan Africa where the rate is going up instead of down.”
The number of Ugandans with HIV doubled between 2004 and 2011, from 1.2 million to 2.4 million. A more blase attitude about AIDS among Ugandans is one explanation, and a more socially and religiously conservative approach to the epidemic from the government of Yoweri Museveni may be another.
By contrast, Malawi has a higher infection rate but a more progressive approach to countering it. Clinton said little about the epidemic during a one-day visit here Sunday. But her very presence as the first U.S. secretary of state to visit Malawi was a mark of regard for the new government of President Joyce Banda, a women’s rights activist who has backed aggressive HIV-prevention programs.
Clinton toured an educational summer camp for girls run by the Peace Corps, where the curriculum includes sexual health and birth control. Later, Clinton’s party bumped down a long dirt track to a U.S.-sponsored milk-production cooperative where farmers can also be tested and treated for HIV.
U.S. officials say about one in 10 Malawians is infected with HIV or has AIDS, a crippling figure. But the rate has fallen from 13 percent over five years, and innovative prevention and treatment programs extend through much of the country. Malawi has cut mother-to-child transmission of the virus, condom use is widely accepted, and a male circumcision program once unthinkable in this traditional society is now oversubscribed.
U.S. officials point to a huge change in public attitudes and awareness over the past decade. In 2002, Malawi suffered the worst famine in 50 years, caused in part by the absence of farmers who were too sick to work or who were caring for sick relatives.
“The government is committed,” said Ritu Singh, who heads HIV and AIDS work in Malawi for USAID. “They understand this is a problem, and they understand this is affecting their people.”
The challenges remain vast, even leaving aside Malawi’s poverty. Per capita income is about $900, more than half the population is dependent on outside aid, and U.S. donations fund the majority of Malawi’s annual health budget.