If there is one area that Uganda has shined, it is
HIV/Aids. But as RICHARD M. KAVUMA writes
on Millennium Development Goal Six, not only is there a
danger of complacency, but the gains being made against
HIV/Aids are threatened by Malaria.
Like the morning after a burial, a strange sombreness engulfed
Kasensero fishing village in Rakai district on October 28.
The previous night had been stormy. Deep in the night,
a boat had capsized and several fishermen had perished.
Among them was the husband of one Grace.
Grace had lived with her husband for only three months.
Women gathered outside their shanty wooden and corrugated
iron houses to talk about Grace’s tragedy, as her
mother struggled to keep her from rolling in the sand and
into the lake water.
“Poor woman!” said Maama Naluyima, “their
love was still very young. She was even beginning to put
Yet from here, Lake Victoria looked calm, except for a
swarm of lake flies a few kilometres off shore that deceptively
made it appear stormy. It was here at Kasensero that the
first case of HIV/AIDS in Uganda was confirmed around 1982.
According to 74-year-old Joseph Mbogo-Munaana, who has
worked here since he was a boy, locals initially thought
that AIDS was a result of witchcraft. It was believed that
some Ugandan traders had robbed or cheated their Tanzanian
counterparts and had been bewitched.
The authorities at the time said AIDS had been brought
by Tanzanian forces who had deposed dictator Idi Amin in
“After falling sick, many traders came back here
and threw merchandise and money they had made from goods
back into the lake thinking it would make them recover,”
says Mbogo, who now builds wooden houses for rent. “Others
took the goods right back to Tanzania.”
A quarter of a century later, AIDS has killed more than
a million Ugandans and threatens to wipe out entire families,
Mbogo himself cannot count how many relatives he has lost
to AIDS. But they include four adult daughters in the early
“In fact the third one was self-employed across the
border in Tanzania,” recalls Mbogo, expressionlessly,
like a battle-hardened fighter, “Then she became very
sick; I fetched her from there and she died here.”
| HELP US LIVE: A girl living
with HIV/Aids pleads for anti-retroviral drugs as a
social worker (left) and other HIV-positive children
listen in Kampala
After the death of his daughters, Mbogo says, he started
advising young people to have more responsible sex lives.
He says although all people know that the disease is transmitted
sexually, their sexual behaviour has not changed much.
“Because of lust, and because people are being told
condoms can protect you from HIV, people’s behaviour
has not changed much,” he says. “People are
told that if one condom can’t work, use two; or that
if you get infected, there are drugs that can keep you looking
Uganda today is like a fishing village the morning after
a stormy, deadly night on the lake – counting its
dead, hoping that the missing will be found alive and thanking
the gods for those who made it.
The storm is HIV/AIDS. The MDG target here is to have halted
by 2015 and begun to reverse the spread of HIV/AIDS. This
is one area where Uganda has scored inspiring success.
National Prevalence rates have dropped from around 15 percent
in 1991 to 7 percent in 2005. This means that in relative
terms, Uganda has already achieved the MDG target.
| The entrance to Kasensero
fishing village, where the first case of HIV in Uganda
According to Uganda AIDS Commission Consultant Dr. Innocent
Nuwagira, this is attributable to the political commitment
right from President Yoweri Museveni, openness about the
pandemic from the early 1990s, and a conducive policy environment
that started with the creation of Uganda AIDS Commission
“When everybody thought talking about HIV/AIDS was
a taboo, the President, Parliament and everybody else opted
to go open,” says Nuwagira.
Uganda has preached a three-way approach: Abstention from
premarital sex, Being faithful and Condom use (ABC).
Nuwagira says the response to AIDS has had three pillars:
prevention of new infections, care and treatment for those
affected and mitigation of the HIV/AIDS impact e.g. orphans,
widows, the workplace etc.
An HIV/AIDS Partnership that includes government departments,
aid agencies, non-governmental organisations, religious
bodies and people living with AIDS meets once a month to
review progress and devise new ways of dealing with the
In its July 2005 report on MDGs, the Ministry of Finance,
Planning and Economic Development notes that the prevalence
rate among pregnant women aged 15-24 may be understated.
But the rates have no doubt dropped, partly due to the death
of many infected people but also due to reduction in new
ABC: So what worked?
Mid last year, an NGO organised an HIV/AIDS awareness and
sensitisation seminar at Kasensero. As is the practice,
the seminar organisers offered the participants money for
lunch and a transport refund. But there were also provisions
Mary Namubiru, a doctor who was conducting the seminar,
was in for a surprise. She arranged two tables: one with
condoms, and the other for people to sign for their money.
“I naturally thought that everyone would scramble
for the money, so I stood there waiting,” Namubiru
recalls. “Instead, everyone rushed for the condoms.”
Namubiru had to send for more supplies. This little incident
seems to confirm a widely held view, that condoms are part
of the solution.
“I don’t think people have changed their sexual
behaviour; what has happened is that condoms have become
crucial,” says Deo Semanda, 29, a carpenter at Kasensero
If this is the case, then President Yoweri Museveni finds
himself in a difficult situation. Along with his wife Janet,
they have over the last two years sought to downplay the
role of condoms in containing the scourge.
Critics allege that this unofficial policy of downplaying
condoms and emphasizing abstinence is meant to get more
American money under the Presidential Emergency Plan for
AIDS Relief (PEPFAR). PEPFAR’s approach is essentially
to promote fidelity and abstinence as opposed to condoms.
During a recent sensitisation seminar at Kikube Village
in Luwero, Caritas, a Church-based NGO, faced a tough question
from a 14 year-old boy. If condoms are bad, he asked, why
are they made and given to people.
While government officials maintain that there is no deliberate
effort to discourage condoms, activists blame persistent
condom shortages on government policy.
This debate about condoms and abstinence is critical; without
a cure for HIV/AIDS, prevention remains the key and public
awareness and education are indispensable.
The government report on MDGs quotes a 2002/03 survey suggesting
that if Universal Primary Education (UPE) was fully implemented,
700 new cases of HIV in young people would be prevented
every year. This is reportedly because educated women tend
to delay sex activity and to take measures to protect themselves.
Another area that is potentially explosive is the fate
of orphans many of them having lost parents to HIV/AIDS:
a 2002/03 Uganda National Household Survey shows that orphans
are less likely to sleep under a mosquito net, less likely
to be in school, and generally more disadvantaged than children
with parents. Government estimates that Uganda has two million
orphan children, half of them due to AIDS, and the figure
is expected to rise over the next decade.
“In our sub county of Kyebe, we have so many orphans
whose parents were taken by AIDS. They have very little
assistance from family members or no assistance at all.
These children need help,” says Mzee Mbogo at Kasensero.
But when asked to list the challenges facing the anti-aids
struggle in order of importance, Mbogo started with drugs.
“We need more treatment. Let us have more hospitals
with more AIDS drugs. Sometimes here we have drugs but there
are no testing machines. Sensitisation campaigns should
also be strengthened.”
The impact of HIV/AIDS cuts across almost all sectors.
It kills skilled and unskilled labour, causes absenteeism
from schools and other workplaces, causes reduced food security,
and generally destroys the social fabric.
Anti-retroviral drugs (ARVs), which delay the onset of
AIDS, are seen as critical to mitigating the impact of the
Official government figures show that 62,000 Ugandans
are on ARVs out of over 150,000 who require them.
Uganda recently suffered a setback when the Global Fund
for HIV, Malaria and Tuberclosis suspended funding over
misuse of the money. While the ban was eventually lifted,
the suspension dented the country’s leadership image.
A big dent in Uganda’s fight against HIV/AIDS has
been northern Uganda, where infection rates remain alarmingly
With some 1.5 million people living in displacement camps
because of the Lords’ Resistance Army rebellion, prevalence
rates here are feared to be twice the national average.
In late 2004, a report by World Vision International showed
the prevalence rate in the north at nearly11.9 percent compared
to 6.2 percent for the country. Gulu, one of the worst hit
districts, reported 69% of deaths as being caused by Aids.
The World Vision blamed the north’s higher rates
on poverty, abduction and rape of girls and women by rebels,
and lack of healthcare, among other factors.
Explaining the Aids problem in Gulu two years ago, Acholi
paramount chief Rwot Onen Acana told this writer that in
an environment of abject poverty, many women and girls were
left with no choice but to prostitute themselves to the
few men with money.
A 2005 National Sero-prevalence and Behavioural Survey
put HIV/Aids prevalence in the conflict-affected areas at
9.1% compared to the to the national average (7%).
The AIDS Control Program executive director Dr. Elizabeth
Madra said last August government would introduce a special
AIDS strategic plan against the spread of HIV/AIDS in the
war ravaged north.
According to Dr. Nuwagira, the ideal situation is an HIV/AIDS-free
Uganda. Although prevalence rates have fallen to 7 percent,
he says, those are hundreds of thousands of Ugandans bound
“For me the most immediate major challenge that this
country faces is to fight complacency,” he says. “We
fear it could be a big problem. Complacency would mean that
people have left what they are supposed to be doing and,
in a way, relaxed.”
Due to Anti-retroviral drugs, people who have been bedridden
get back on the road and look healthy. There is fear they
could default on the drugs, plunge into ill health and increase
The commission is also hearing unconfirmed reports that
people who begin to look healthy again are remarrying, with
hope to raise families and have children through prevention
of mother-to-child transmission.
“That is why we are very concerned; most of our effort
now is geared at seeing how best we can prevent complacency,”
Dr. Chris Baryomunsi, United Nations Population Fund (UNFPA)
Programme Manager in Kampala, is concerned that the prevalence
rate has stagnated for virtually the last four years.
Although Uganda has got a lot of money to support its fight
against HIV/AIDS, it must use the money properly and increase
access to programmes like anti-retroviral therapy and testing
Baryomunsi: “The issue of scaling up services is
very important but also the issue of prevention especially
for younger people is a key concern because when you now
listen to what people say, you tend to think that provision
of ARVs is all we need to do with HIV. But prevention is