Confronting AIDS in Uganda.

`The solution will come from the community.'

When I sat down to talk with Joel Arimadri Tivua in the 6-by-10 foot office he shares with two others coordinating the AIDS program at Uganda's Kuluva Hospital, I didn't expect to hear good news. One of the main reasons that AIDS has so devastated Africa is that there has been little awareness or understanding of the virus or its causes--especially in rural areas such as this, in the rolling tobacco fields of northwest Uganda.

"In African culture, it is a taboo to talk about sex," Tivua explains. "As a result, children are not exposed to their sexual rights."

In Uganda, this lack of education about the possible consequences of sexual activity has resulted in the highest number of reported AIDS cases in Africa--nearly two million in the late 1990s, according to U.N. figures. However, Uganda's government was also the first to respond to the epidemic by engaging religious and traditional leaders and other members of civil society in an effort to confront the crisis at its behavioral roots.

The core of Kuluva's program is the Philly Lutaya Initiative, named after the first Ugandan to openly reveal--in hopes of saving others--that he was HIV-positive. Through this program, people living with HIV/AIDS receive regular checkups and meet together weekly for support and discussion. They also do outreach at schools, marketplaces, and churches, and even have a weekly broadcast on the local Christian radio station, giving testimonies about how they acquired the virus, how they are living with it, and how to prevent it.

KULUVA HOSPITAL also trains community-based counseling aides from surrounding villages. These counselors refer and follow up on patients for HIV-testing, help to reduce stigma by sensitizing their communities to the issues surrounding HIV/AIDS, and even start income-generating activities to raise money to support their AIDS clients. As a result, many communities are starting to realize that AIDS is a community problem and cooperate with the hospital in both education and care.

"We tell them," says Tivua, "that the solution will not come from the Western world, the solution will not come from Kampala, the solution will not come from Kuluva--the solution will come from the community. As a result, they feel that they have a responsibility."

The walls of the check-up room adjacent to Tivua's office are papered with nationally distributed posters urging people to protect themselves by "abstaining, using a condom, or creating a conducive environment for mutual faithfulness." These messages are being heard in the community. Studies now demonstrate that Ugandan youth are learning safer sexual behavior--later initiation, fewer partners, and more condom use. Also among the posters are charts demonstrating a trend reflected nationally--the number of HIV cases has declined to 36.7 percent of those tested at Kuluva, compared to 49 percent of those tested in 1996.

"That shows there's a behavior change," says Tivua, "though behavior change is a process, and it is gradual."

But while community-based education efforts are vital for AIDS education and prevention, institutional support is still needed for testing and care. So far, Kuluva's program has been funded by a five-year government project, which is starting to phase out. The staff is uncertain as to how their program will continue without a new source of stable support. "It's about sustainability," says Tivua. "How are they going to sustain this program in the community? Because AIDS has come to stay--unless something is done about it."

A SAMPLING OF AIDS BILLS BEFORE CONGRESS

* Global Health Act of 2000. Calls for a $1 billion increase for existing global health programs, including a $275 million increase to fight HIV/AIDS.

* Global AIDS Prevention Act of 2000. Authorizes $2 billion in appropriations for HIV/AIDS efforts and calls for the U.S. Agency for International Development to prioritize HIV/AIDS efforts in its foreign assistance programs.

* Mother-to-Child HIV Prevention Act of 2000. Addresses the issue of mother-to-child transmission of HIV/AIDS in Africa, Asia, and Latin America.

* AIDS Marshall Plan. Establishes a program to provide assistance for HIV/AIDS research, prevention, and treatment activities in Africa.

RYAN BEILER, news/Internet assistant at Sojourners, traveled to Uganda in March. For more information, contact: The AIDS Control/Care Programme, Kuluva Hospital, Box 28 Arua, Uganda; [e-mail].