Are Condoms Still Key to Ugandan AIDS Fight?

The Ugandan government has hit back at accusations it is promoting sexual abstinence over condom use, jeopardising significant gains made in the fight against AIDS.

Critics say pressure from the US government has forced the change in policy, with health groups suggesting that messages conveyed to Ugandans via billboards and radio advertising over the last six months have increasingly focused on abstinence and faithfulness.

AIDS activists also claim President Yoweri Museveni’s government is withholding condoms from the Ugandan market and have threatened to appeal to the country’s Human Rights Commission if more aren’t made immediately available.

But the government denied the country is suffering from a shortage or has abandoned its three-pronged ABC strategy – Abstinence. Be faithful. Use Condoms – which has seen Uganda’s HIV rate fall from more than 30 per cent of the adult population in the early 1990s to about six per cent today.

"In the next 12 months or so, we are going to buy more than 200 million condoms," said Alex Opio, assistant commissioner of health services in the national disease control department. "How is it possible that a country that supposedly doesn't support condoms is making condoms available?"

Deputy Minister of Health Mike Mukula said the government distributes only five to eight million per month, however, because flooding the market would result in products expiring or rats damaging those sent to camps in war-torn northern Uganda.

Though the government insists that no shortfall is expected over the next year, a problem with the US-supplied Engabu condom brand did result in a scarcity this spring when the authorities sidelined 30 million for testing.

Critics insist, however, that even when the condoms were given the all clear by the National Drug Authority, the government was slow to respond. "The government decided it would first restore the confidence in that brand through advertising and staging press conferences," said Arthur Mpeirwe, legal adviser for the Kampala-based Coalition for Health Promotion and Social Development, an umbrella group of 38 health organisations. "But they kept quiet, thus escalating the crisis through May, June, July, August."

Though the Engabu condoms are due to be relaunched this month, accusations are flying that the US, influenced by powerful, right-wing Christian groups at home, is pushing Museveni to promote abstinence.

The UN's special envoy on fighting HIV/AIDS in Africa, Stephen Lewis, was the latest to echo criticism that emerged last spring about the US government's alleged manipulation of Uganda's AIDS policy.

"I'm not throwing a conspiracy theory here. It's not a matter of conjecture or dispute. Condoms don't rank as high [on the agenda]," said Lewis, who has travelled throughout Uganda and receives much of his information from local AIDS activists and international health groups like Health Gap International.

American Christian groups wield power over government policy in the US, which, in turn, as the largest donor in Uganda, exercises influence over the government of President Museveni, he said.

Some critics go further. Michael Ruhindayo, general manager of Kampala-based Health Rights Action Group, blames American born-again Christians for directly influencing Museveni. He said each year at least 120 religious figures such as American evangelist Bishop TD Jakes visit Kampala's 2,000 Evangelical Christian churches. Many, like Jakes who has counselled US president George Bush, gain an audience with Museveni.

Health activists have also pointed fingers at first lady Janet Museveni, a staunch Christian who has encouraged an AIDS prevention strategy featuring abstinence-only programmes. She told students in an address given last year at Makerere University in Kampala that condoms were not foolproof and therefore may spread sexually transmitted diseases and cancer, said Beatrice Were from the NGO ActionAid International.

Lewis says he has also heard first-hand remarks by the president favouring sexual abstinence over other measures - at odds with the UN conviction that condom use is the single most effective way to prevent AIDS.

In one such episode in July 2004, Museveni "diminished the role of condoms as a useful prevention device" in a speech given in Bangkok for the International AIDS Conference, Lewis explained. "Everyone was taken aback by his comments."

"You could feel the ground shifting right from Bangkok," added Were.

A spokesperson with the Office of the US Global AIDS Coordinator denied claims that US government policy to promote abstinence has led to a condom shortage in Uganda. “We are spending more on AB [Abstinence. Be Faithful] programmes,” she said. “But we are also spending more on condoms than ever before.”

The Ugandan government further argues that for two years it has adopted a so-called ABC-Plus policy that includes prevention of mother-to-child HIV transmission, anti-retroviral drug treatment and caring for vulnerable groups. It said Uganda maintains a comprehensive billboard policy on AIDS awareness that includes an equal mix of ads discussing both abstinence and condom use.

Mukula described as "absolute rubbish" the claim that condom-focused billboards have been removed. He said the use of condoms has risen over three years from 33 per cent to 83 per cent as a result of the government's AIDS campaign.

At the offices of the ministry of health, Alex Opio showed IWPR a box of condoms clearly marking the US as its place of origin, as proof that Washington still supports Uganda's ABC strategy.

"This year alone, I would say we have received over 30 million condoms from the US government through USAID," said Opio.

Professor John Rwomushana, director of research and policy at the government-established Uganda AIDS Commission in Kampala, attributed claims that the US is pressing Kampala to promote abstinence over condom use to a combination of false information, health organisations' desire for attention and AIDS activists' fears they will lose donor funding if they fail to hammer home the ABC message.

A national survey conducted by government and other groups earlier this year showed the HIV rate holding at six to seven per cent among adults, says Rwomushana. That said, Uganda continues to experience HIV/AIDS rate spikes in the usual hotspots of seaports, roadside stops and areas of conflict.

Fawzia Sheikh is a regular IWPR contributor.