By Sam L. Ruteikara
Monday, June 30, 2008
KAMPALA, Uganda -- The President's Emergency Plan for HIV-AIDS Relief (PEPFAR) has been mired in the Senate for months. Last week finally brought signs that a vote, and passage, could be near. The program would cost $50 billion -- that's $165 from each American to fight AIDS, or $1.3 billion from New York City alone. But will the money allocated for AIDS stop the spread of the virus in sub-Saharan Africa, where 76 percent of the world's HIV-AIDS deaths occurred last year?
Not if the dark dealings I've witnessed in Africa continue unchecked. In the fight against AIDS, profiteering has trumped prevention. AIDS is no longer simply a disease; it has become a multibillion-dollar industry.
In the late 1980s, before international experts arrived to tell us we had it all "wrong," we in Uganda devised a practical campaign to prevent the spread of HIV. We recognized that population-wide AIDS epidemics in Africa were driven by people having sex with more than one regular partner. Therefore, we urged people to be faithful. Our campaign was called ABC (Abstain, or Be Faithful, or use Condoms), but our main message was: Stick to one partner. We promoted condoms only as a last resort.
Because we knew what to do in our country, we succeeded. The proportion of Ugandans infected with HIV plunged from 21 percent in 1991 to 6 percent in 2002. But international AIDS experts who came to Uganda said we were wrong to try to limit people's sexual freedom. Worse, they had the financial power to force their casual-sex agendas upon us.
PEPFAR calls for Western experts to work as equal partners with African leaders on AIDS prevention. But as co-chair of Uganda's National AIDS-Prevention Committee, I have seen this process sabotaged. Repeatedly, our 25-member prevention committee put faithfulness and abstinence into the National Strategic Plan that guides how PEPFAR money for our country will be spent. Repeatedly, foreign advisers erased our recommendations. When the document draft was published, fidelity and abstinence were missing.
And somehow, a suspicious statistic attacking marriage appeared. The plan states that the HIV infection rate among married couples is 42 percent, twice as high as the rate among prostitutes. Our requests for the source of this statistic were repeatedly ignored. In fact, the 2004-05 Ugandan HIV/AIDS Sero-Behavioral Survey found that HIV prevalence among married couples is only 6.3 percent, far lower than infection rates among widowed (31.4 percent) or divorced (13.9 percent) Ugandans.
When Washington insiders were alerted to these scandals, the words "abstain" and "be faithful" were quietly reinserted into the plan -- on paper. But that doesn't guarantee these methods will be implemented or promoted. Meanwhile, the dubious marriage statistic remains.
As fidelity and abstinence have been subverted, Uganda's HIV rates have begun to tick back up.
Western media have been told this renewed surge of HIV infection is because there are "not enough condoms in Uganda," even though we have many more condoms now than we did in the early 1990s, when our HIV rates began to decline. Condom promotions have failed in Africa, mostly because fewer than 5 percent of people use condoms consistently with regular partners. Indeed, the loudest HIV-prevention message in Africa is "universal access" to condoms, testing, anti-retroviral treatment, and assorted other drugs and devices. All these commodities must be transported, stored, distributed, advertised and resupplied endlessly.
Meanwhile, effective HIV prevention methods, such as urging Africans to stick to one partner, don't qualify for lucrative universal-access status.
Do not misunderstand me: Treatment is good. But for every African who gains access to HIV treatment, six become newly infected. To treat one AIDS patient with life-prolonging anti-retroviral drugs costs more than $1,000 a year. Our successful ABC campaign cost just 29 cents per person each year.
International suppliers make broad, oversimplified statements such as "You can't change Africans' sexual behavior." While it's true that you can't change everybody, you don't have to. If the share of men having three or more sexual partners in a year drops from 15 percent to 3 percent, as happened in Uganda between 1989 and 1995, HIV infection rates will plunge. It is that simple.
We, the poor of Africa, remain silenced in the global dialogue. Our wisdom about our own culture is ignored.
Telling men and women to keep sex sacred -- to save sex for marriage and then remain faithful -- is telling them to love one another deeply with their whole hearts. Most HIV infections in Africa are spread by sex outside of marriage: casual sex and infidelity. The solution is faithful love.
So hear my plea, HIV-AIDS profiteers. Let my people go. We understand that casual sex is dear to you, but staying alive is dear to us. Listen to African wisdom, and we will show you how to prevent AIDS.
The Rev. Sam L. Ruteikara is co-chair of Uganda's National AIDS-Prevention Committee.