IYD: News & Views - Why Uganda?

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Shepherd Smith is founder and president of the Institute for Youth Development, a non-partisan, non-profit organization that promotes a consistent, comprehensive risk-avoidance message to youth for the leading harmful risk behaviors. His articles appear in newspapers across the country.

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WHY UGANDA?

By Shepherd Smith, 4/1/2003

With the topic of Iraq on everyone’s mind, let’s not overlook a lethal killer that continues to take its toll worldwide. AIDS is decimating entire countries, creating legions of orphans, drastically reducing the labor force in many parts of the world and contributing to famine. President Bush has talked about Uganda when addressing the AIDS issue. But, why Uganda?

The statistics are staggering. Forty-two million people worldwide are currently living with HIV/AIDS. Approximately 29.4 million live in sub-Saharan Africa where almost three million children are infected with the virus. In 2002, approximately 2.4 million Africans died of the disease. By 2010, there will be an estimated 20 million AIDS orphans in Africa.

The United States has not been spared -- the effort to stop this disease is failing. Since 1998, the number of newly-diagnosed adults with HIV has averaged just over 40,000 a year. Recently, it has become apparent that the U.S. rate of HIV infection is beginning to rise. This is an alarming trend that must be stopped dead in its tracks.

For those searching for answers on how to stop the spread of this disease, it may be surprising to learn that a small country in Africa – Uganda – is waging a uniquely successful battle. This is especially remarkable in light of the fact it spends just $13 per capita in total healthcare annually while the United States spends forty times that amount on HIV/AIDS alone.

During the past decade, Uganda has actually reversed the incidence of new HIV infections. It has also experienced a dramatic decrease in total infections. Estimates by the U.S. Census Bureau/Joint United Nations Program on HIV/AIDS (UNAIDS) are that national HIV prevalence in Uganda has fallen to 5% in 2001 from 15% in 1991. This is amazing progress, and I believe there is something we can learn from their experience.

It’s important to understand the three key elements behind this noteworthy progress. Ugandan President Yoweri Museveni, who entered office in 1986, has implemented aggressive measures, and has demonstrated a consistent, long-term commitment to the effort. Because of the civil war following the ouster of Idi Amin, he had few foreign “experts” to call on for advice – a fortunate event as it turns out.

First, President Museveni launched a broad-based educational campaign to raise awareness and promote change. This campaign was implemented through traditional communication channels such as the media and the schools, as well as at the grassroots level. And he and his wife have spoken out repeatedly about AIDS.

Second, and most importantly, President Museveni believed the Ugandan people could be convinced to change their behavior and eliminate the risk of exposure. Based on this belief, he created the “Uganda ABC model.” The acronym “ABC” stands for the practice of Abstinence prior to marriage, Being faithful after marriage, and using Condoms 100% of the time if you are married to an infected partner or engage in sex outside of marriage. (Many refer to Uganda’s program as ABc since Ugandans have utilized condoms infrequently.)

Third, during the past decade he enlisted more than 700 government and non-governmental organizations throughout the country to work on this issue. He has relied very heavily on faith-based and community efforts and has supported these groups so they can continue their work at the local level. More recently, as an extension of this effort, he has also built partnerships with health experts and researchers worldwide including the Centers for Disease Control and Prevention, UNAIDS and the World Health Organization.

This is a unique model because it relies on a triad of actions – as opposed to a single-focus campaign such as “safe sex” through condom usage. The single-focus approach has been a dismal failure in many parts of the globe although it has been supported by most AIDS experts. In Botswana, for example, where the condom model is used, it’s estimated that a staggering 40% of the adult population is infected. Published research indicates that the exceptionally low rate of consistent condom usage is to blame. Many other observers are now concluding a lack of emphasis on abstinence and faithfulness is the largest contributor to high HIV infection rates.

What can the U.S. learn from this experience? In President Bush’s State of the Union speech and other recent appearances, he pledged his commitment to the “ Uganda model,” and has recommended that the U.S. follow Uganda in the war against HIV/AIDS. In addition, he has asked Congress to commit $15 billion over the next five years to turn the tide against AIDS around the world.

Having recently been to both Uganda and Botswana, we have seen first-hand the suffering experienced by families and children because of HIV. We have also seen the tremendous difference a properly-focused, well-executed program can make in stopping its spread: lives saved vs. lives lost.

President Bush has it right. We need to emphasize abstinence and faithfulness. This will enable us to launch a strong offensive against the disease, and put an end to unnecessary suffering in the U.S. and around the world. It’s a subject we cannot afford to ignore because of its impact on our culture, our economy and the future of all youth.

Distributed by Knight Ridder/Tribune Media Services