Dismay as Uganda moves away from condom promotion.

Uganda is redirecting its HIV prevention strategy for young people away from scientifically proven and effective strategies toward ideologically driven programmes that focus primarily on promoting sexual abstinence until marriage. This redirection of HIV/AIDS policies is manifest at all levels, from the president's office to the classroom. In November 2004 the Uganda AIDS Commission released a draft "Abstinence and Being Faithful (AB)" policy to guide the implementation of abstinence-until-marriage programmes throughout the country. Intended as a companion to the country's existing strategy on the promotion of condoms, the policy in fact undermines condoms as an HIV prevention measure and suggests that promoting condoms alongside abstinence messages would be "confusing" to youth. The new school curriculum excludes information on safer sex and HIV risks within marriage, and early drafts, yet to be finalised, provide misleading information about the effectiveness of condoms in the prevention of HIV transmission.

In October 2004 the Ministry of Health issued a nationwide recall of all free government condoms, in response to "failed quality control tests" although the test results varied between laboratories and have been challenged by the manufacturers. The government has also demanded the re-testing of already tested, imported condoms, leading to forecasts of a national condom shortage and an increase in importation costs of more than 500%. Rather than take steps to address the shortage, Uganda's Minister of State for Primary Health Care stated "As a Ministry, we have realised that abstinence and being faithful to one's partner are the only sure ways to curb AIDS. From next year, the Ministry is going to be less involved in condom importation but more involved in awareness campaigns, abstinence and behaviour change."

The influence of US-driven policy is obvious despite substantial evidence from within the US that abstinence-only programmes have little influence on participants' sexual behaviour and may cause harm by discouraging the use of contraception and increasing the risk of sexually transmitted infections when sex is initiated. An estimated 6% of the adult population in Uganda is currently infected with HIV, significantly less than the estimated 15% national prevalence a decade ago and Uganda has been rightly praised for this achievement. However, the country still faces a generalised HIV/AIDS epidemic and cannot afford to drop proven HIV prevention strategies and adopt discredited ones. (1,2)

In 1992 only 2% of the predominantly Catholic population of Rakai district used condoms even though HIV prevalence locally was 44%. Now, despite the campaign against condoms by the church, around 66% of the population use condoms and HIV/AIDS prevalence has been reduced to 12%. (3)

(1.) Human Rights Watch. The less they know, the better: abstinence-only HIV/AIDS programs in Uganda. At: <hrw.org/reports]2005/uganda0305>.

(2.) Bass E. Fighting to close the condom gap in Uganda. Lancet 2005;365:1127-28.

(3.) Condom use in Rakai, Uganda, reaches 66% [Update]. Women's Global Network for Reproductive Rights Newsletter 2005;84(1):27.