uganda is the model

Jack Bloom

Uganda had the highest prevalence of HIV in the world in 1992, when about 18percent of the adult population was infected. But it reduced that to about 6percent by 2002.

President Yoweri Museveni and his wife Janet took the lead in creating awareness of the disease as a national health emergency and they involved all sectors of society in prevention efforts.

Meanwhile, the incidence of HIV in Southern Africa has rocketed to just less than 40percent in Swaziland and Botswana, and about 20percent in South Africa.

The Gauteng legislature's health portfolio committee recently visited Uganda to learn from their experience in combating HIV-Aids.

The Uganda Aids Commission (UAC) was formed in 1992 by statute of parliament and was first chaired by the president himself.

"The president would stop and talk to banana sellers in the road about HIV-Aids. Everybody followed the president's lead," a UAC representative said.

Fear played a large role in behaviour change in line with the fervently promoted ABC prevention message of abstain, be faithful and condomise.

Virtually every family had lost a relative to Aids and employees often stayed away from work for weeks attending funerals.

The number of single men who had multiple sex partners dropped from 55percent in 1989 to 29percent in 1995.

The percentage of women between 18 and 24 who first engaged in sex before they turned 18 dropped from 74percent in 1995 to 58percent in 2006; for young men the figures dropped from 64percent to 42percent in this period.

Teenage pregnancy plummeted from 43percent in 1995 to 25percent in 2006.

Condoms were not a key factor in the early reduction in HIV infection. Their use has risen, but is still relatively low and inconsistent. In Gauteng 150million condoms are distributed each year, compared with 120million in Uganda with a population three times as large.

The billboards we saw were much more direct than the cryptic messages LoveLife often uses in South Africa. "Say no to Sugar Daddies", screamed one, "She's keeping herself for marriage . what about you?" asked another.

Antiretroviral therapy with AZT was started as early as 1992 by a truly remarkable man, Peter Mugyenyi, a professor who President Museveni asked to found the Joint Clinical Research Centre in 1990. It is a non-profit organisation that works closely with government departments.

The centre dispenses ARVs to more than 50000 people and has pioneered user-friendly, cost-effective and less toxic drug regimens. Treatment now requires only one combination-drug pill taken daily.

Mugyenyi says he cannot operate within the government's bureaucracy and he accepts money from international donors only on his own terms.

"Your money is poison," he told one donor, explaining that imposed foreign consultants knew nothing of local conditions and chewed up most of the money ineffectively.

About 40percent of those eligible for ARVs in Uganda receive them, a higher percentage than in South Africa, which has vastly superior health resources.

Ironically, an emerging problem in Uganda is that the normalisation of the disease and the availability of ARVs has lowered perceptions of risk, leading to signs of a resurgence of the epidemic.

HIV prevalence stabilised for many years at slightly above 6percent, but is now inching towards 7percent. There is a worrying upward shift in HIV cases among married couples between 30 and 40, and an increase in extramarital sexual partners.

A relaunch of prevention efforts is planned to overcome the complacency that has set in. Those who are on ARV treatment need education to become a resource in preventing further infections.

The biggest threat, says Mugyenyi, is that drug-resistant HIV strains are arising from poor adherence to treatment. Second-line drugs are five times more expensive, and third-line drugs 10 times more. So adherence councillors are crucial to ensure the sustainability of long-term treatment. Socio-economic development is also crucial because tablets will not be taken on an empty stomach.

Uganda's progress in HIV-Aids prevention and treatment owes much to inspired leadership, both from the very top and from social entrepreneurs like Mugyenyi.

Our failure of political leadership shows up painfully, but we can make amends by learning from Uganda's experience.

l Jack Bloom is DA leader in the Gauteng provincial legislature.