Uganda's Early Gains Against HIV Eroding

'Fear Is Stronger Than Love'

Scientists identified Uganda's first case of AIDS, a mysterious new disease beginning to appear across Africa, in 1982. But a government response in this mostly rural country of 28 million came only after Museveni, a blunt, charismatic rebel leader, ended years of civil war by taking control in 1986.

That year, he sent 60 military officers to train in Cuba. Eighteen tested positive for HIV in routine screenings there, according to Museveni's advisers. At a conference that year in the Zimbabwean capital of Harare, Cuban President Fidel Castro told Museveni, "Hey, brother, you have a problem."

Museveni soon huddled with his top doctors and focused on what they knew: A fatal, incurable, sexually transmitted disease was on the rampage. The only solution, they decided, was to urge Ugandans to stay faithful to one sexual partner or, if in polygamous marriages, to those spouses.

The dominant message was, in Museveni's simple but evocative phrasing, "zero grazing," an agricultural term inspired by the zero-shaped patch created when livestock were tied to a post and allowed to eat only from a single section of grass.

Billboards went up. Songs were sung. The national radio broadcaster, which in that era dominated public airwaves, started each day at 6 a.m. with the rumble of war drums followed by the soft voice of a schoolgirl pleading, "Father, I'm still too young. Please don't die. Be faithful."

AIDS programs of the time had rough edges. In a documentary on Lutaaya chronicling his decline from energetic Afro-pop superstar to a man barely able to walk, he is shown wincing as a group of village women sing sweetly, "AIDS was inflicted upon the rebellious, the promiscuous and the criminals."

While warning against stigmatizing those with the disease, Lutaaya didn't flinch from his core message. "Changes must be made in our sexual behavior," he tells one group shown in the film. "If we don't work hard, the human race is going to die."

This message worked because of the passion of the delivery and the dynamics of HIV, which spreads most easily among networks of men and women with several ongoing sexual relationships, researchers say.

Such arrangements declined sharply in the years after Lutaaya's campaign. The number of Ugandan men reporting three or more non-marital sexual partners fell from 15 percent to 3 percent between 1989 and 1995, according to World Health Organization reports.

The HIV rate in Kampala, once estimated at as high as 30 percent, fell dramatically. Some of that resulted from an estimated 1 million AIDS deaths, but Uganda -- a rarity among African countries -- also experienced a steep and sustained drop in new infections.

"You change because of fear. And you change because of love," said Jesse Kagimba, a longtime AIDS adviser to Museveni. "Fear is stronger than love."

Fewer Casual Sex Partners

During the zero-grazing era, Museveni resisted promoting condoms on the grounds that they offered false hope that the epidemic could be stopped without curbing multiple sexual partnerships.