THE TRUTH ABOUT UGANDA'S SEX-ED CAMPAIGN AGAINST AIDS

	Abstinence-only classes in which students are taught about remaining sexually inactive until marriage. They are trained how to say "no" to sex. They are kept ignorant of methods to prevent transmission of Sexually Transmitted Diseases (STDs). Contraception to prevent pregnancy is also not taught.
	Comprehensive sex-ed classes in which students are taught about the benefits of choosing celibacy. But, for those who are sexually active or who may decide to become sexually active in the future, they are also taught how to lower the chances of STD transmission and pregnancy.

Many Fundamentalist and other Evangelical Christian group promote abstinence-only classes. Focus on the Family and some other Fundamentalist Christian organizations are promoting experiences in the African state of Uganda as proof of the effectiveness of abstinence-only sex-ed classes. This appears to be invalid information. In fact, the Ugandan campaign is a comprehensive sex-ed program, teaching:

	Abstinence to the sexually inactive,
	Monogamy to married couples, and
	Condoms to prevent STD transmission for almost everyone who is sexually active.

The Ugandan story according to SIECUS:

The Sexuality Information and Education Council of the United States (SIECUS) describes the Ugandan program as a comprehensive plan involving both abstinence for those who wish to remain sexually inactive, and the use of condoms for STD prevention for those who wish to be sexually active.

SIECUS wrote that: "Uganda has been lauded as the most successful HIV/AIDS prevention case in Africa, as it is the only country in sub-Saharan Africa where the incidence of HIV/AIDS has decreased."

When President Yoweri Museveni took power in Uganda in 1986, he gave priority to fighting the country's growing AIDS epidemic. The administration established the Ugandan National Task Force on AIDS in 1990. It started as a narrowly focused STD prevention program, involving condom distribution and promotion through popular songs, drama groups, counseling and support services. This was expanded in 1995, and became a comprehensive sex-ex program. Included were additional "approaches to promote safe sex, abstinence, fewer sex partners, and condom use among young people." President Yoweri Museveni stated, "We encouraged community based initiatives and our campaign has produced a lot of mass networks. We encouraged condom use and in ten years have seen it go up from 7% to 42%."

On the negative side, Museveni refuses to acknowledge that homosexuality exists in his country. He believes that HIV infection only spreads in his country by three methods:

	Unprotected heterosexual sex.
	Transfusion with infected blood.
	Tribal customs such as circumcision. ₁

The President appears to be in a very small minority.

Amnesty International issued a report in 2001-JUN documenting numerous cases of homosexuals who had "held illegally for up to two weeks in illegal detention centres, army barracks and police stations before being released without charge. A number of Ugandans fled the country fearing arrest. In November President Museveni stated that homosexuals could live in Uganda as long as they kept their sexual orientation secret." ₂Most public health authorities feel that driving homosexuality underground is guaranteed to increase HIV infection which causes AIDS.

The Ugandan story according to the Ugandan AIDS Commission (UAC):

The UAC appears to be solidly behind a comprehensive plan to reduce the transmission if HIV through a three-pronged promotion of "behaviour change" among the general population -- specifically:

	Abstinence,
	Monogamy, and
	Condom usage.

The UAC's first listed priority is "to reduce HIV prevalence by 25% by the year 2005/6." Their first listed method of accomplishing this goal is through the promotion of "behaviour change (abstinence, faithfulness and safer sex) among the sexually active populations, particularly young people aged 15-25." ₁₃

UAC Secretariat:

The 1994-1998 National Operational Plan for HIV/AIDS/STD Prevention, Care and Support of the Uganda AIDS Commission states:

"The main emphasis of the Plan will be prevention of HIV-infection through behaviour change, promotion of STD-care and condom use for targeted groups of people with focused educational messages. The promotion of behaviour change will focus not only on the individual behaviour, but will equally focus on the collective behaviours, and the norms and the values of the community." "In order to achieve this," indicates the Plan, "it is necessary to give first priority to children and youth and to start addressing norms and values right from school entry, gradually making it more specific as the child grows." The second priority of the Plan is to address the status and needs of women, including rural women, and the third is to address cultural and traditional customs and specific sites with concentration of risk behaviours." ₃

UAC National Aids Documentation Centre" (NADIC):

NADIC is funding Community-led HIV/AIDS Intitiatives (CHAIs). NADIC's Project Brief discusses "Eligible Activities under CHAIs." The only eligible activities for prevention of HIV transmission which can obtain funding are:

	"Local information, education and communication activities like music, dance and drama aimed at HIV/AIDS prevention and mitigation."
	"*Safer sex education including condom promotion*, storage and distribution." (Emphasis ours)
	"Information on the dangers of STDs and prevention of Mother-to-Child-Transmission of HIV/AIDS." (Transmission can be greatly reduced with certain medication given to pregnant woman, and through the avoidance of breast feeding by infected women).

Abstinence is not specifically mentioned in the entire project brief. ₁₂

UAC "Practical Information Sheet":

The UAC web site features a "Behavior Change" sheet titled "A very simple message." It says in part:

"We thought that the AIDS epidemic was just a little river that we could dam easily; Now we realize that it is a real flood that rises inexorably; Many people start loosing hope; They forget that if you cannot dam a flood you can escape by getting into a boat. People are different, they need different boats."

"There are three kinds of boats called: 'Abstinence', 'Fidelity' and 'Condom' People are argued [sic]: 'Do not stay in the water, get into a boat.' The boat of your choice. If you feel that you cannot stand the life on board, do not fall back into the water; Switch from one boat to another." ₁₅

The sheet continues, recommending that Ugandan's:

	Talk honestly and openly with your spouse or partner about how safer sex can protect both of you from HIV/AIDS.
	Start practicing some of the safer sexual behavior listed above, use condoms and protect yourself, say no to sex if your partner will not accept to use a condom.

They sum up their message with:

BE RESPONSIBLE..

Say "No to unsafe sex!"

LEARN HOW TO SAY NO.

Finally, their information sheet concludes with 19 suggested statements that women can say to their partner or spouse. Seven relate to the use of condoms:

	"Yes I love you. But we still need to use condoms."
	"Being in love can’t protect us against disease; We still need to use condoms."
	"I want to start using condoms now so we won’t be at risk any more."
	"It’s simple! I absolutely will not have sex without using a condom!"
	"Using condoms is not a matter of trust. It’s a matter of health."
	"Let’s use condoms. It’s important to me that we’re both protected."
	"Worrying about disease isn’t romantic. With condoms we won’t need to worry."

The National Strategic Framework for HIV/AIDS Activities in Uganda:

The NSF has published an executive summary, which notes:

In Uganda, "There has been an overall decline in HIV positive sero prevalence rates...from 30 to about 10% between 1992 and 1996...it appears to have stagnated since."

"...the mechanisms that produced this reduction are not fully understood. Owing to weak monitoring, it is not possible to apportion the observed decline between the three factors of abstaining, being faithful to one’s partner, and condom use."

Information, Education and Communication (IEC) programs centered on the promotion of safer-sex practices and improving the quality of life of persons with HIV/AIDS. Of the close to 1,500 agencies involved in HI/AIDS. nearly 70% were involved in IEC work. As a result of their efforts:

	The proportion of sexually active persons who ever used a condom rose from 7% in 1989 to 42% in 1995.
	The increase in the median age at which girls became sexually active increased by about six months between 1989 and 1995 to about 16 years of age.

However, they note that their are many constraints in the promotion of IEC:

	Most people, particularly those who live in rural areas, cannot obtain or afford condoms. They recommend that condom accessibility and affordability be improved.
	The proportion of people who use condoms properly is not known.

They note in their recommendations for the period 2000/2 to 2005/6 that" "Widespread awareness of the epidemic, openness and less stigmatisation of individuals, increased condom use, and significant mobilisation of local NGOs and CBOs for provision of care and social support to people infected and affected are some of the achievements made and should be further strengthened and sustained." They note that "the reduction in the proportion of HIV positive persons cannot be apportioned between abstinence, being faithful, and condom use." They recommend that "A representative survey on knowledge, attitudes, beliefs and practices regarding HIV/AIDS needs to be carried out during the early part of the implementation of this framework." Only then will the effectiveness of the three approaches -- abstinence, monogamy, and safer-sex -- be determined. They will then be able to gear their future programs accordingly.

The Ugandan story according to Johns Hopkins University:

The Population Information Program, of the Center for Communication Programs, at Johns Hopkins School of Public Health, regularly publishes Population Reports. Their 1999-APR issue discussed how condom promotion programs have succeeded well around the world. They cited the countries of Nepal, Senegal, Thailand, and Uganda.

They also describe the Ugandan program as a comprehensive plan involving both abstinence for those who wish to remain sexually inactive, and STD prevention for those who wish to be sexually active.

They note that at one time, Uganda had the highest HIV infection rate in the world. "While most other developing countries have since seen increases in HIV/AIDS, Uganda has seen a decrease of up to 25% in the HIV infection rate compared with the rate in 1980." It is the only country in sub-Saharan Africa where the incidence of AIDS has decreased. "In 1991 a multi-sectoral program began, including condom distribution and promotion involving popular songs and drama groups, counseling, and support services. In 1995 a nationwide promotion campaign started—with songs and soap operas, drama, posters, and other approaches promoting safe sex, abstinence, fewer sex partners, and condom use among young people (286). There was a subsequent rise in age at first sexual intercourse and in monogamy and a decrease in HIV prevalence, especially among young people. The percentage of pregnant women with HIV has dropped since 1991, based on blood tests at five sites. The use of condoms has increased substantially among young people. Among men ages 15 to 19, the percentage who had ever used condoms rose from 20% in 1989 to about 60% in 1995." ₄

The Ugandan story according to Dr. Edward Green of Harvard:

The Christian Connections for International Health (CCIH) web site has published a report by Edward C. Green of the Harvard School of Public Health. ₉He reports that:

	Faith based organizations (FBO) in the country emphasized behavioral change "on what they called abstinence (or 'delay') and fidelity." Sometimes, this was the sole emphasis; condom usage was not mentioned.
	Teenagers in Uganda are now delaying their first sexual experience by two years on average, from 15 to 17 years of age.

Dr. Green also reports that only about 7% of women and 10% of men aged 15-50 reported that they have adopted complete and sustained abstinence for HIV protection.

Dr. Green states that "It is reasonably well-established that consistent condom use protects against HIV transmission, therefore condom use should be promoted."

The Ugandan story according to Focus on the Family:

After hearing repeated references to the Ugandan abstinence program on Family News in Focus radio program, we searched the Focus on the Family web site for references to Uganda. We found many reports on the Ugandan program. All appear to imply that it is an abstinence-only program, and/or that increased use of condoms and safer-sex precautions have played no significant role in the reduction of HIV incidence in that country:

"Uganda has found great success in publicly promoting abstinence until marriage to its young people. In 1994, Uganda launched 'True Love Waits,' an abstinence-until-marriage program that was also supported by schools, religious institutions, non-governmental organizations and local communities." ₅Assuming that the program took two years to get fully up to speed, then it would have been fully effective in 1996, the year when the reduction in HIV incidence in Uganda leveled out. That is, the great reduction in HIV incidence happened before True Love Waits was fully effective, and has stagnated since.

Focus on the Family quote a 2002-FEB-16 letter of Edith G. Ssempaia, Ugandan ambassador to the United States which commented on the abstinence part of their comprehensive program: "We believe that the abstinence campaign in Uganda has had a significant impact on HIV infection, which has declined by 50 percent between 1992 and 2000, and the decline has been most marked in the 15-24 age bracket." ₆

"Secretary Powell seems to be ignorant of the fact that Uganda has made great progress against AIDS by emphasizing abstinence, not condoms. Uganda has cut the rate of HIV infection by as much as 50 percent among young people by delaying the onset of sexual activity by two years." ₆

In a report on 2002-JUL-26, Focus criticized the International AIDS Conference that was recently held in Barcelona, Spain. At the conference, speakers concentrated on various "safe-sex" practices as the best approach to reducing the HIV infection rate. As an example:

	, Professor Paul Gundani, 42, a Roman Catholic theologian at the University of Zimbabwe read a list of names of people in his family who have recently developed AIDS. He said: "My sister (died) last week, and my brother last year. By now, my nephew may be dead, too." He spoke in front of a poster which said, "Because the bishops ban condoms, innocent people die." The poster was an apparent reference to the stand of a number of Roman Catholic bishops in Africa -- and the Roman Catholic Church itself -- who oppose the use of condoms -- not only for the prevention of pregnancy but for the prevention of HIV infection.
	Former president of South Africa, Nelson Mandela promoted the teaching of "enlightened" practices to prevent HIV infection.
	A representative from the children's TV program Sesame Street told the conference that the South African version of their show will feature an HIV-positive Muppet.

Pete Winn of Focus wrote: "What was not mentioned in Barcelona, however, was the fact that there is little evidence that condoms are having an effect, while the evidence is mounting that abstinence and traditional morality do have an impact." ₁₀Winn provides a hyperlink to the Uganda Aids Commission, which he says "Condom use was not listed among the commission's recommendations." Strictly speaking, this is a true statement -- but only because a graphic on condom use ("condom_use.jpg" 22,571 bytes) cannot currently be read on the UAC web site; the file is apparently inaccessible. ₁₁Also, as noted above, the Uganda AIDS Commission's web site discusses condom promotion extensively.

In another report, Focus attributes the entire success in Uganda to the abstinence component of their comprehensive sex-ed program: "Uganda, where more than 30,000 kids have signed abstinence pledges, has seen a 50-percent reduction in AIDS since 1992 because of its emphasis on abstinence." ₇

SinceUganda has a population of 20.3 million, ₂ and about 67% of the population is less than 25 years of age, 30,000 pledges represent a tiny percentage of the total youth, perhaps on the order of 0.5%.

In another article supplied by Focus on the Family reporter Pete Winn to the Baptist Press quotes Edward C. Green, of the Harvard School of Public Health. Green is quoted as saying that the focus on abstinence has reduced HIV prevalence rates by 70% between 1991 and 2001. Pete Winn also quotes an unidentified Demographic and Health Survey which reports that 95% of all Ugandans age 15 to 49 now report practicing either monogamy or abstinence. ₈

Attempts to get an accurate picture of AIDS prevention in Uganda:

	Pete Winn of Focus on the Family quotes a Demographic and Health Survey which states that 95% of all Ugandans age 15 to 49 claim to practice either monogamy or abstinence.
	Edward C. Green of the Harvard School of Public Health reports that about 8.5% of Ugandans age 15 to 50 practice abstinence.
	If both values are correct, then about 86.5% of Ugandans in this age range must be practicing monogamy.
	That leaves 5% who admit to having multiple sexual partners, of which some fraction use condoms to prevent AIDS transmission.

These data appear to conflict with the report that abstinence programs are only delaying the onset of sexual activity among teenagers by two years. We are attempting to clarify this conflict.

References:

"Policy Update - March 2002: HIV/AIDS programs continue to be a source of conflict," Sexuality Information and Education Council of the United States (SIECUS)
"Uganda," Amnesty International, at: http://web.amnesty.org/
"Introduction," Food and Agriculture Organization,
"Condom promotion works," Johns Hopkins University, at: http://www.jhuccp.org/pr/h9/h9chap7_4.stm
"Dobson addresses condom effectiveness," Focus on the Family, 2002-FEB-24, at: http://www.family.org/cforum/feature/
"Focus on the Family Denounces Powell’s Pro-Condom Comments
Dr. James Dobson Calls on President Bush to Repudiate Secretary of State’s Remarks," Focus on the Family, 2002-FEB-14, at http://www.family.org/welcome/press/
Bob Kellogg, "European Journal Questions Effectiveness of Sex Ed ," Focus on the Family, 2002-JUN-28. at: http://www.family.org/cforum/fnif/news/
Pete Winn, "Abstinence seen as crucial in solving Africa AIDS crisis," Baptist Press, 2002-JUL-25, at: http://www.sbc.net/redirect.asp?
"Evidence on impact of abstinence and fidelity in AIDS prevention - Part 1," Christian Connections for International Health, 2001-NOV-21, at: http://www.ccih.org/ccih-news/01-25.html
Pete Winn, "Death's Door," Focus on the Family, 2002-JUL-25. at: http://www.family.org/cforum/feature/A0021550.html
"Uganda Aids Commission: Frequently Asked Questions,"
Uganda HIV/AIDS Control Project (UACP): Project Brief,
Uganda Aids Commission: Mandate and Background,"
"Executive Summary," The National Strategic Framework for HIV/AIDS Activities in Uganda.
The Behavior Change sheet was adapted from B. Joomet and T. Mugolola's book "The Fleet of Hope: teachers book." Unfortunately, neither Amazon nor Barnes and Noble list the book.

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