HIV activists are struggling to find ways to address one of Uganda's biggest health crises: soaring HIV infections among couples, caused largely by cheating spouses. The subject can be too politically and culturally sensitive to discuss.
The face of Uganda’s AIDS epidemic is changing. In the 1990s, the country brought down its infection rate dramatically with a campaign advocating ABC - abstinence, being faithful and condoms. The government urged people to get off the so-called “sexual network” and into stable, committed relationships, which were considered safe.
But that is no longer true. According to the results of a national survey released last year, more than 40 percent of new infections are happening among married couples.
Sandra Kyagaba works with the National Community of Women Living with HIV/AIDS. She said more than half the women who come to them are married.
“Most of them when they come, they will share with you and say, ‘I contracted HIV from my husband, [and] I was really faithful.’ That means the husband was not faithful," she explained. "It’s really very common here.”
The issue of infidelity was thrust into the limelight recently by a billboard in downtown Kampala. Put up by the U.S.-based AIDS Healthcare Foundation, or AHF, it read, “Cheating? Use a condom. Cheated on? Get tested.”
AHF’s Omonigho Ufomata says the organization is prepared to be blunt if it will help people protect themselves and their partners. “We are trying to drive at the heart of what’s raising infection rates in Uganda, and also other places all across the world, actually. So we’re taking a pragmatic and practical approach," Ufomata stated. "Saying that people stray outside of relationships. It’s not about judgment, it’s not about trying to change that behavior or criticize it, but simply that people protect themselves and protect their partners.”
But the billboard outraged many Ugandans, who saw it as condoning infidelity. Religious leaders protested, and the government-run Uganda AIDS Commission ordered AHF to take it down, telling the media the billboard was spreading the “wrong message.” Organizations should instead be advocating fidelity, said the commission’s director.
The billboard has since been removed, but a number of activists, including Kyagaba, say its message was simply realistic. Infidelity is ingrained in Ugandan culture, she said, and efforts to bring down infection rates must take that into account.
“Some cultures think that having more than one wife is a prestige, is being big in manhood, and all that. So even if I don’t tell you to go and cheat, I know you are going to do it. It’s common in Africa. So it’s better you have that information within you that if you are going to cheat on me, or have someone else, then it’s better you use a condom,” Kyagaba said.
The only way to fight the epidemic, she said, is for Ugandans to speak honestly about their behavior - something that has not been happening enough.
“With HIV, the communication has to change. Once you communicate in abstracts by beating bushes, then someone won’t get the message. Sometimes you need to be direct for someone to get the message right,” noted Kyagaba.
With infection rates rising for the first time in 20 years, nearly everyone in Uganda agrees that something needs to change. But activists and the government have yet to agree on what.