KAMPALA, Uganda - Aid workers and foreign activists say Uganda is moving away from the highly successful “ABC” formula that won the country international recognition as Africa’s leader in the fight against AIDS.
The pioneering formula — which stands for “abstain, be faithful or use a condom” — helped the government reduce the infection rate in Uganda from 18 percent to 6 percent in a decade.
But the infection rate remained at 6 percent in recent years and rose to 7 percent in the most recent Health Ministry survey. Critics say this is because the government — influenced by evangelical Christians — has de-emphasized condom use, focusing exclusively on abstinence and marital fidelity.
A government official involved in AIDS issues, who refused to be named, said the shift reflects the influence of first lady Janet Museveni, a vocal evangelical Christian. She has persuaded many people, including President Yoweri Museveni, to stress abstinence and marital fidelity over condoms, the official said.
Health Minister Jim Muhwezi insists that evangelicals do not dictate policy, adding that it is appropriate for the government to preach abstinence to young Ugandans.
“If those are protected when they are young, then when they get partners, they will use behavior change, which means being faithful to their partners,” he said.
“Then this will go a long way to stop the spread of AIDS. And those who cannot stop use condoms.”
Stephen Lewis, the United Nations’ special envoy to Africa on AIDS, said a speech by Mr. Museveni at a global AIDS conference in Bangkok last year made clear that “it has been a deliberate government policy to shift the emphasis from ABC to AB.”
“All you had to do was be in Bangkok to hear Museveni’s speech to know that condoms were falling into disrepute” in Uganda, Mr. Lewis said in a conference call arranged by health activists and Human Rights Watch.
Jennifer Bakyawa, who heads the National Guidance and Empowerment Network of People Living with HIV/AIDS, said, “Several countries have copied Uganda’s model of A and B and C.
“And then they’ve been saying, ‘Yeah, this is a story we’ve been sold for years and years. Then you turn around, and you say: ‘By the way, much as we sold you C, C doesn’t really work.’ You are not even faithful to yourself.”
From last October to this June, condoms were in short supply in Uganda as an estimated 30 million remained on the warehouse shelves of Population Services International and Marie Stopes International, awaiting government approval for distribution.
A double-testing procedure introduced after the discovery of a suspect batch of free condoms late last year now requires all condom shipments to be tested before importation.
AIDS activists demonstrated this week outside the New York offices of the Ugandan Permanent Mission to the United Nations to protest what they called a deliberate government policy to halt the distribution of condoms.
“The condoms are there, but what is in woeful shortage is the political will of Ugandan leaders to distribute them and promote condom use,” said activist Sharonann Lynch.
Uganda’s AIDS program suffered another blow last week when the Global Fund to Fight AIDS, Tuberculosis and Malaria suspended more than $150 million in grants to the country, citing financial mismanagement.
The fund said the Project Management Unit in the Health Ministry, which distributes the money, had not adequately accounted for grant expenditures, while other expenses were unexplained, inappropriate or improperly documented.
Independent AIDS workers deplored the suspension, but they said the unit had lacked transparency from the beginning.
They said many staff in the unit lacked skills for the work, including the project coordinator. The unit’s employees have been sidelined as a government investigation into the purported mismanagement gets under way.
“This small hitch with the Global Fund, it doesn’t affect our success story” with AIDS, Mr. Muhwezi said.
The fund wants the government to get rid of the Project Management Unit and to redesign by late October the way it receives and distributes the grants.
Citing Mr. Muhwezi as an example, anti-corruption activists say there is a lack of political will by the government to crack down on graft.
The state ombudsman has accused Mr. Muhwezi of influence peddling in his current position. In 1998, when he was a junior minister, Parliament censured him for failing to explain how he became wealthy in a short time.
Meanwhile, Ugandan and foreign activists accuse the Bush administration of undermining the ABC formula by underwriting faith-based groups.
Since 2003, the President’s Emergency Plan for AIDS Relief has delivered more than $200 million to Uganda — more than 10 percent of that country’s annual budget.
More than $15 million of the U.S. contribution has gone to abstinence-only programs, according to the U.S.-based Center for Health and Gender Equity, an advocacy group.
Mr. Lewis accused the United States of “obsessive” and “irrational” emphasis on abstinence in the fight against AIDS.
“How can this apply to married women?” the U.N. envoy said. “How can they save themselves from infection if they suspect their husbands of infidelity? Nor can it apply to sexually active adolescents.”
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