Uganda is winning international praise for its success in fighting HIV and AIDS, even as the rate of infection soars in other parts of Africa. The country's prevention approach, known as ABC - or abstinence, being faithful and condom use - has been credited with changing the sexual behavior of Ugandans and contributing to a dramatic drop in the number of new HIV cases. The method has also been adopted by the Bush administration as its primary prevention tool, in more than a dozen AIDS embattled countries.
Uganda is one of the world's least developed countries, but it is being hailed as a rare African success story in the fight against AIDS.
The country has seen a 50 percent drop in HIV cases over the past decade, though the disease remains the leading cause of death among adults. The United Nations AIDS program, UNAIDS, says by the end of 2003, the rate of HIV infections dropped from a high of about 15 percent, to about five percent in urban areas. Other sub-Saharan African countries, like Zambia and Namibia, are recording HIV rates in the double digits.
International health officials and the Ugandan government attribute the decrease to an aggressive prevention campaign touting the safe sex practices of abstinence, being faithful to one partner, and the regular use of condoms, or ABC.
Dr. Mazuwa Banda, an HIV specialist with the World Health Organization and the Global Fund's coordinator for Africa, says the ABC method has resulted in wide-scale behavioral changes among Uganda's 25 million residents.
"Uganda is one place where there is quite some evidence that we have on behavior change in the course of the epidemic," Dr. Banda said. "The prevention campaign focused on promoting abstinence and the reduction in the number of sexual partners, as well as the use of condoms in high-risk situations. Subsequently, people began to change their behavior. And behavior usually started to change more in the younger age group, the 15-24 age group."
Dr. Banda says teaching safe sex practices to younger Ugandans has been key in slowing the spread of the virus. He adds that the method is being tailored to especially reach out to women and girls.
But critics say the ABC approach is not sufficient to protect women, whose rate of infection with the disease is growing faster than among men.
Dr. Geeta Rao Gupta, of the International Center for Research on Women, says prevention needs to focus more heavily on gender-based violence, reproductive rights, and adequate health care for women.
"Because women are economically vulnerable and dependent on men, they are more likely to get infected by selling sex for money, goods or favors, less likely to be able to negotiate protection with a sexual partner, and less likely to leave a risky relationship even if they know it's risky and less likely to be able to cope with the illness once infected or care for loved ones who are infected," Dr. Gupta explained.
Despite its limitations, Uganda's ABC approach has been implemented by governments in several other countries, including Botswana, where an estimated 35 percent of the adult population is infected with HIV. The ABC method has also been adopted by the Bush administration as the primary prevention tool of the president's promised five-year, $15 billion global AIDS plan. The initiative targets 15 AIDS afflicted countries in the Caribbean and sub-Saharan Africa, including Uganda, Lesotho, Nigeria, and Haiti.
Some AIDS activists say the Bush administration and Uganda's President Yoweri Museveni have focused the ABC program too heavily on abstinence, while downplaying the importance of condom use.
But President Bush's Global AIDS coordinator, Randall Tobias, says all three methods work in tandem.
"There is no one right answer to preventing the spread of this pandemic" Mr. Tobias said. "And those who want to simplify the solution to just one method, any one method, simply do not understand the complexity of the problem."
International health experts say much of Uganda's success in fighting AIDS has been due to the strong political commitment of President Museveni. The Ugandan leader has also reached out to the country's influential religious community to help spread the message about fighting AIDS.
Dr. Jonathan Mermin is the country director in Uganda for the U.S. Centers for Disease Control and Prevention. He says the aggressive public information campaign lessened the stigma attached to the disease.
"The current President of Uganda, President Museveni, took power after a very difficult civil war. But he started to talk about HIV in every speech he gave for the next decade," Dr. Mermin noted. "He was very open to international collaboration, trying to help with the HIV epidemic. He has [exerted] great effort in supporting the indigenous, non-governmental organizations that are involved in HIV care and prevention to flourish. He has also supported the Uganda government through the ministry of health and his own office."
Dr. Mermin says other key elements of Uganda's AIDS program include the widespread availability of HIV testing and the provision of funds and other support for the treatment of AIDS patients.