Uganda's Leader Beats Drum on AIDS

President Museveni asserts that HIV rates fell sharply mainly because of abstinence.
President Museveni asserts that HIV rates fell sharply mainly because of abstinence. (By Michael Makutu -- Associated Press)
By Nora Boustany
Friday, September 30, 2005

When Ugandan President Yoweri Museveni decided it was time for African leaders to break their silence about the AIDS epidemic, he evoked tradition: When danger approaches, he told them, village leaders beat their drums to send out a warning.

Nelson Musoba , a Ugandan physician devoted to fighting the disease, remembered that the president told his countrymen and leaders of neighboring countries that the scourge of AIDS was at their doorstep, threatening the lives of men, women and children, "and about that, you cannot keep quiet."

Museveni's early efforts in the fight against HIV-AIDS have been commended. But his more recent assertion that the HIV rate actually increased in Uganda when condoms became more widely available has proved less laudable.

"The correct approach is ABC," he told Washington Post editors and reporters last week, referring to Uganda's three-pronged approach in fighting the epidemic: Abstain, Be faithful, use a Condom. "Abstain. If you cannot do the first, try for the second, and only as a last resort, go for the third. If you don't have a condom, why should you commit suicide?" he said.

When efforts to combat the epidemic began in the 1980s and more condoms were being handed out, he said, the prevalence of HIV went up. "People relaxed the rule of abstinence," he said, adding that the dramatic drop in his country's HIV rate has primarily resulted from abstinence.

Museveni's recent argument has raised some brows among health professionals.

"I don't think you can attribute the reduction to one single strategy, or cause," commented Musoba, who heads the Action Group for Health, Human Rights and HIV/AIDS.

Musoba acknowledged government success in "laying down a good plan, strategy and health policy. . . . Abstinence has helped, and so has the open discussion promoted in schools via the printed word and audiovisual materials, as has the availability of condoms."

The number of Ugandans with HIV has fallen from 33 percent to 7 percent this year, said Musoba, who also works as a consultant for the Ministry of Health.

He is here to help lobby Congress to approve $600 million to help in the fight against AIDS. Some of the money will go to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was set up through a U.N. initiative three years ago. Musoba said the $3.5 billion that has already been approved was vital to curbing the epidemic in Africa, where in many countries the percentage of HIV-infected people has reached double digits.

The greatest challenge in Uganda, he said, is the scarcity of resources. Musoba has supervised health care facilities with 50,000 patients but only one or two doctors.

"The pay is so low that 100 of 200 graduating doctors leave Uganda each year. We are looking for ways to keep well-trained health care professionals at home," he added.

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