Debate rages over abstinence
Sheena Kaiza (not real names) spends her evenings in Capital pub, a dark, busy and noisy bar in the red light district of Kabalagala, a suburb south of the capital Kampala. Even when her motives are questionable, the 21-year old mother of two does not consider herself a prostitute. “I just ask for a beer, and give him company. If he takes me home, then in the morning I ask him to help me with some money to pay my rent. “That is not prostitution. It’s an understanding,” she says.
Because you seem to believe her, Sheena will confide in you. “But I cannot sleep with a man without a condom. Who will take care of my children if I contract HIV?” she says, proudly showing me a pack of Protector Condoms. Sheena has heard about HIV/Aids, and the Ministry of Health’s Abstinence, Be Faithful, use Condoms (ABC) strategy to fight it.
But she believes more in the condom. “Abstain? Why would I? You don’t lose anything having safe sex, do you?” she says, lighting a cigarette. In Kampala today, there are many like Sheena who use sex as a source of livelihood. Their bodies have become assets; tools of survival. And if they can use a condom, then they can have sex. That is as far as Uganda has gone in the fight against HIV/Aids. Even high risk groups like prostitutes know the importance of “gum boots” “CD’s” or “rubber” as condoms are called.
Although rural areas especially conflict zones like northern Uganda, access remains scanty, condoms are sold almost all shops and supermarkets in the urban centres for as low as Uganda 30 US cents for a packet of three. In certain clinics they are distributed free of charge.
Uganda’s President Yoweri Museveni has received the credit for the country’s HIV/Aids success story, among other things, three international awards. The ABC strategy has been credited with helping to reduce HIV prevalence in the country to 6 percent today from 30 percent in the early 1990s, a reversal many attribute to his government's frankness about the role of condoms in fighting the disease.
However, experts and rights groups have raised concern over a draft “Abstinence and Being Faithful (AB)” policy released in November 2004 by the Uganda AIDS Commission. It cautions that providing information about condoms alongside abstinence can be “confusing” to youth. Rights groups say, a policy that denies especially young people information about any method of HIV prevention other than sexual abstinence until marriage, is jeopardizing Uganda’s progress.
On March 30, the US-based Human Rights Watch released a report criticizing the US-funded ‘Abstinence-only’ programmes, which they say “was bound to hijack Uganda’s AIDS success story because of the implications it could have particularly on the younger generation.” The U.S. government has already budgeted U.S. $90 million this year on abstinence-only programs in Uganda as part of President George W. Bush’s global AIDS plan.
The 80-page report, “The Less They Know, the Better: Abstinence-Only HIV/AIDS Programs in Uganda,” documents the recent removal of critical HIV/AIDS information from primary school curricula, including information about condoms, safer sex and the risks of HIV in marriage. “Uganda is gradually removing condoms from its HIV/AIDS strategy, and the consequences could be fatal,” said Tony Tate, a researcher with Human Rights Watch’s Children’s Rights Division and the report’s co-author.
According to the report, draft secondary-school materials state falsely that latex condoms have microscopic pores that can be permeated by HIV, and that pre-marital sex is a form of ‘deviance.’ “These abstinence-only programs leave Uganda’s children at risk of HIV,” said Jonathan Cohen, a researcher with Human Rights Watch’s HIV/Aids Program and one of the report’s authors. “Abstinence messages should complement other HIV-prevention strategies, not undermine them,” he says.
In May 2004, Museveni changed position on the ABC strategy, saying that condoms should now be given only to sex workers. His change of mind coincided with the US announcement that Uganda would receive the $90 million fund. Since then, he has made similar statements in other speeches. His wife Janet has also publicly condemned condoms as inappropriate.
Last year, the First Lady called for a ‘census’ of virgins as part of the fight against HIV/Aids. "We need to find out the percentage of the youth who never had sex, those who have reverted to secondary abstinence," Mrs Museveni said. In December, she also hosted a party for some 70,000 virgins countrywide.
The recalling of batches of the Ngabo brand condoms late last year for alleged failed quality control tests, also caused a countrywide condom shortage and left unanswered questions on government’s sudden restriction on condom imports and new position.
The abstinence - only did not work in the US, rights groups argue. Can it work in a developing country where 38 per cent of the population lives under the poverty line (on less than US$ 1 a day)? “Abstain only? How will you measure it? It is going to be counter -productive. You will just get more people contracting HIV,” says Chris Baryomunsi, HIV/Aids advisor, United Nations Population Fund (UNFPA). “My view is that it (abstinence-only) doesn’t work because the figures we have show that that young people in Uganda are sexually active,” Baryomunsi says. Studies show that by the age of 15, 30 percent of girls have had sex, and by 18 years, 72 per cent would have done so, Baryomunsi says.” They are more sexually active at a younger age. So we need a combination of various strategies to fight HIV. Those who can abstain can do so,” he says.
Medical personnel also have their own views. Biologically, it’s difficult to totally abstain, especially when one has had sex before, says Dr Vincent Karuhanga, a private practitioner in Kampala. “When they talk about abstaining, it just means to stop for some time. You can abstain for a few hours. But it is most difficult if you ever had a good sex encounter before,” he says. “Only certain conditions may force you to do so. And sex is one thing that nobody wants to talk the truth about. They may say they are abstaining when it’s not true,” Karuhanga says.
James Tumusiime, a newspaper editor believes there is indeed no need to break up the ABC as the combination works well. “It (abstinence) may work for some, but not for others. No single method can work alone .“Effective prevention requires a combination of different measures,” he says.