KAMPALA — Uganda enjoyed tremendous success reducing its AIDS prevalence rate in the 1990s through a campaign based on the ABCs: Abstain, Be Faithful or Use a Condom. Now new infections are on the rise again. As health workers struggle to keep HIV in check, the country is moving beyond its celebrated ABC message to new prevention strategies.
By 1986 - four years after the first AIDS patient was diagnosed in Uganda - the country was in the middle of an epidemic. Some cities in the country diagnosed nearly one out of every three people with HIV.
The following year the country started rolling out a homegrown campaign built around the ABCs of HIV prevention: Abstain, Be Faithful or Use a Condom. The campaign’s key message, borrowed from an agricultural practice, was "Zero Grazing." It meant stay faithful to your partner. The country rode that message until HIV prevalence dropped to around 5 percent.
Milly Katana has been one of the country’s foremost AIDS activists since she learned she was HIV-positive in 1995. She says ABC was critical in two key ways.
"One, alerting the general public about the dangers of HIV," she said. "But also, offering people some options on what we need to do as far as addressing the imminent challenges and the risks associated with sexuality. For sure, as humans… we cannot stop sex. But if there is a potential risk, like HIV, it was very instrumental in saving a few lives.”
However, a recently released AIDS Indicator Survey showed new infections are on the rise again in Uganda. Though the increase was less than one percent, the news alarmed health workers and activists. Uganda’s ministry of health says most new infections come from people who report they are in long-term relationships, but have multiple sexual partners. In his recent State of the Nation address, President Yoweri Museveni said Ugandans had "relaxed" in following the ABCs.
In order to prevent a sharper rise in new infections, Dr. Bernard Etukoit says the country’s emphasis is shifting to biomedically-proven prevention strategies that have been developed since Uganda’s initial ABC campaign. Etukoit, the director of programs for the AIDS Support Organization, calls the approach "combination prevention."
"In light of limitation and availability of resources, then priority has to be on evidence-based, high-impact prevent strategies. So, basically the trajectory has been from ABC to now, evidence-based, biomedical prevention strategies with a high impact," he said.
He says for Uganda, the most important of these strategies are preventing transmission of HIV from mothers to their children, and safe male medical circumcision, which can reduce the chance of HIV transmission by up to 60 percent. Over the last year, the country has strengthened plans for both strategies, though limited resources mean neither service is universally available.
Katana says there remains a need for updated ABC messaging in combination with the range of prevention strategies.
"The ABC strategy still has room in the current epidemic… Whereas in the early years, we were talking about zero grazing, the messaging now is being slightly modified into getting off sexual networks," she said.
Anne Gamurorwa oversees a campaign to reduce HIV in young people called Young, Empowered and Healthy, or YEAH She says for ABC to be effective in contemporary Uganda, it must include more specialized information.
She says young people understand the importance of ABC, but the message is too broad. They told her that they find it difficult to follow because it does not explain how to navigate real-life situations. YEAH, centered around a radio program called Rock Point 256, provides information specific to those concerns.
“We are doing ABC, but we are not saying do this or this or this or this. It is for them to decide," she said. "The beauty of this project is that it looks at the underlying factors to vulnerabilities of young people… and also it models, it shows them how you can change.”
If the message is heard, young people will learn that prevention is not as easy as ABC.