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The AIDS Pandemic: Saving the Next Generation
HER EXCELLENCY JANET K. MUSEVENI
It is my pleasure, ladies and gentlemen, to share with you the Ugandan experience of the struggle against HIV/AIDS, and how, as a country, we initiated and used the ABC policy to stem the spread of HIV among our population.
On behalf of the President of the Republic of Uganda, and on my own behalf, I want to begin by thanking you very much for inviting us to be part of this very important gathering. I am happy to be able to represent my husband who could not stay long enough because of other engagements. He has asked me to convey his gratitude to you, Mr. President and to the Institute, for having taken a keen interest in the developments in Uganda, for your kind thought of honoring us, and for your work at the Institute.
It is my pleasure, ladies and gentlemen, to share with you the Ugandan experience of the struggle against HIV/AIDS, and how, as a country, we initiated and used the ABC policy to stem the spread of HIV among our population. I am aware that I am speaking to people who are also involved in the struggle against this pandemic, and who also have stories and breakthroughs they need to share, because we should all learn from one another. In sharing Uganda's experience, my hope is that you either learn something new and useful or that that at least our story will re-affirm what you already know in the area of HIV/AIDS prevention.
The world has been in the struggle against HIV/AIDS now for twenty years. We are told that over 60 million people worldwide are infected with the disease, and millions of them have died. Sub-Saharan Africa has been the worst affected region so far, with a current total of 30 million infected people actually slightly more than 50% of the world's infected population and many millions dead already.
Although Uganda was badly hit by HIV/AIDS in the 1980s, the country has demonstrated resilience, and has made progress in the fight against the disease. Around 1987, Uganda was one of the worst hit by the epidemic, and the situation looked very bleak.
It needs to be remembered that in 1987, Uganda was just emerging from a 5 year war. However, before that, the country had suffered from bad governance and civil unrest for 2 decades. All of that left the country's economic and health infrastructure in shambles, poverty levels were at their highest, and the traditional, social and cultural fabric of society was greatly weakened. Uganda was therefore at its most vulnerable.
But in a short space of time, between the 80's and late 1990s, the HIV zero-prevalence rates in Uganda had dropped by two thirds; from a high 30% in 1990, in certain groups of the population, to less than 10% by the end of the 1990s. Currently the prevalence rate in the general population is at 6%.
It is the experience of how we managed to reduce the infection rate to these levels in a space of less than two decades and against a backdrop of economic disadvantage that I wish to share with you now.
Uganda's Response to the HIV/AIDS Challenge
In 1986, very shortly after my husband became President he openly acknowledged AIDS as a national development problem. The Government set up an AIDS Control Program in the Ministry of Health in the same year. In 1990, the Government decided to adopt a multi-sectoral approach to control AIDS. The approach emphasizes the role of every citizen in the struggle against HIV/AIDS. A special body, the Uganda AIDS Commission, was set up, not in the Ministry of Health, but in the Office of the President, in 1992.
The job of the Uganda AIDS Commission is to plan, oversee, coordinate and monitor the national response to the epidemic in this broader national context.
Using this strategy, the country has managed to concentrate on four key interventions: Prevention; Care and Support; Impact Mitigation; and Strengthening of Capacity. These interventions have benefited from the collective efforts of the various players at different levels, both in the country and from the international community.
Mass information and education campaigns, spearheaded by the President of Uganda, have equipped the population with key messages on vulnerability and prevention of HIV transmission. Messages were addressed to the general public, and we developed specific messages for the more vulnerable or high-risk groups within the population. As a result of this intensive and continuous information and education campaign, general awareness of HIV/AIDS in Uganda is now rated to be at 99.7%.
But what was the content of these messages? What was the direction of this information campaign?
This brings me to the issue we are discussing today, and therefore, having given you a brief background of the strategy of Uganda in its totality, I will now focus on the content of the key messages of the information campaign which, we are now convinced beyond doubt, assisted us to lower the infection rate to its present relatively low levels.
Faced with a totally new disease, with no known cure even to the scientific world, the political leadership of the country decided to resort to the African, or Ugandan, method of communication. In times of trouble and emergency, African communities used to employ a special method of communication to raise an alarm either by sounding a special drum-beat, or by shouting in a special manner. At the sound of either, entire communities would rise; special precautions would be put in place to preserve life; everyone would be alerted and they would know that they have to take special precautions.
The AIDS epidemic provided just such a situation, and so it could not be left to the Ministry in charge of national health, because we realized, early enough that a disease which was sexually transmitted and had no cure or treatment was more than a disease; it was a national disaster that could destroy entire generations of our people and cripple our economy and national development.
Our only option was to sound a very loud alarm. The responsibility had to be shouldered by the one with the loudest voice, and that was the Political Leader, President Yoweri Museveni.
The message was simple, and it was this: that AIDS is transmitted mainly through heterosexual contact (in the Ugandan context); that it has no cure and leads to death; that young people can avoid it by completely abstaining from sexual activity until they are married; married people should stick only to their marriage partners and be faithful, and those who have risky lifestyles should use the condom to reduce the likelihood of infection or re-infection in the case of the already infected.
President Museveni required all his ministers and all Government officials to include these messages in their addresses to and interaction with the population, and to take into account the impact of HIV/AIDS on the nation in all their planning processes.
Soon, all the religious leaders embraced the education campaign and used their pulpits and numerous care ministries to the people as dissemination avenues for the same messages.
Schools mainstreamed the messages into their syllabuses and developed a special curriculum on Sex Education, which emphasized the message of sexual abstinence for the young people. Electronic and print media, as well as the performing arts, also contributed to the dissemination of the same message. Local community leaders were sensitized and trained to ensure that every group of people was reached in the most appropriate manner by people they trusted and respected.
Looking back, I can say that the message of Abstinence and Faithfulness has been effective in Uganda for four main reasons. First of all, it is simple and uncompromisingly strong in its intention, and it is delivered continually and with consistency. Secondly, the alarm that was sounded by the political leadership has been taken up and magnified a thousand times by every responsible citizen.
The third reason for the effectiveness of the message of Abstinence and Faithfulness is that it was based on the traditional and cultural beliefs and moral framework of the people of Uganda. Traditionally, in Uganda, sexual purity was required among the young unmarried women. It brought great shame and dishonor to the family, if, upon marriage, a daughter was found not to be a virgin.
In some cultures, long ago, if a girl became pregnant before marriage, she would be pushed over the edge of a high cliff to her death by her own brother, in order to protect the family honor. Of course, these undesirable customs are no longer practiced, but the collective memory of the people still exists, and they still attach great importance to observing strict sexual morals. Happily, sexual purity and faithfulness to one's marriage partner were also emphasized by the Christian tradition when it was introduced in Uganda, a century ago. Even the people of the Muslim faith attach great importance to strict moral conduct among the young.
Therefore, even though foreign influence and civil unrest have had their disruptive effect upon the youth, the moral fabric of the Ugandan society is, by and large, still strong and has been a good base upon which to build the strategies of abstinence and faithfulness, in the struggle to inculcate a culture of discipline and self-control in our young people.
In this struggle, Faith-based Organizations have played a major part, because they have structures, which cater for all categories and groups of people, they are motivated by their religious beliefs to preserve life, and they are trusted by the people. Parents, too, have been major actors in the struggle, because faithfulness needs to be modeled and be seen to work in the home and family context, and young people need to be counseled, guided and affirmed in the framework of family love. That foundation is a pre-requisite for successful work with the youth.
The fourth reason why the message of Abstinence and Faithfulness has been effective in Uganda is that people have been confronted with the horror of death, first hand and at close quarters. There is no person, young and old, in Uganda, who has not witnessed a loved one, a family member, or a neighbor, suffer horribly and die prematurely because of AIDS. In such a situation, facts tend to speak for themselves. The sight of fallen comrades is a strong deterrent, and a clear sign that a change in behavior is called for.
My own work in all this has been mainly among the children, the youth, and the women, because these tend to be the most vulnerable groups in society in times of disaster. More than a million children have been orphaned in Uganda in recent years, mainly as a result of HIV/AIDS. Through a non-governmental Organization run by a network of women volunteers all over the country, which I founded 18 years ago, programs to mitigate the impact of HIV/AIDS on orphans and their foster families are carried out.
A package of economic and social interventions has been refined over the years to empower foster families in poor communities to take better care of the vulnerable children in their households, ensuring better nutrition, higher incomes, household food security, and skills developments for the youth who are unable to complete formal schooling.
Working with Ugandan parents and some friends from the US, I founded another Organization more than ten years ago, called the Uganda Youth Forum. My desire was to create a meeting point where we could hold a running dialogue with the youth in Uganda, who seemed to be a generation in danger of being confused and lost.
As a result of more than twenty years of bad governance, civil unrest and the turmoil of war, the traditional Ugandan extended family system was eroded; entire families had perished, in some cases. Traditional and religious values appeared irrelevant to the realities on the ground in Uganda at that time, and the young people, who did not know the standards and the glory of earlier times, were in imminent danger of losing their sense of direction, and becoming cynical about human values.
Through the Uganda Youth Forum, we have been able to train the younger generation and instill values and discipline, or at least provide another alternative method of life-style, which shows a light at the end of the tunnel, and also speak candidly about issues concerning their sexuality. As a matter of fact, some of the strategies we have employed have been borrowed from American Christian culture; for example, "True Love Waits" was a very popular method of guiding our young people towards sexual purity before marriage. But it must be said that the most effective message of Sexual Abstinence is the one found in our very own cultural and spiritual foundations and values.
Finally, let me say something about the matter of the Condom the C in the ABC strategy.
Uganda does advocate for condom use as one of the methods of reducing the rate of infection in the population; but we target such messages to those categories of adults who are either already infected with HIV, or who have risky lifestyles and are so set in their ways that they cannot change their behavior. Right from the start, interventions of faith-based Organizations, particularly, emphasized the fact that the condom was not 100% effective in preventing infection, so our people know that there is always an element of risk involved.
Condom use, as a preferred method of prevention or reduction or infection, is definitely not in the interest of Ugandans. Our people are still poor and the majority of them still live in remote villages in rural areas. Even if they had money to buy condoms regularly, they would find it a problem to access them. When condoms are not used consistently, they are even less effective. Therefore, it is wiser to show our people that there is a surer way to stay safe and alive; because the truth is that there is no "safe sex" outside of the situation of faithfulness to a partner.
Giving young people condoms is tantamount to giving them a license to go out and be promiscuous; it leads to certain death.
In the words of President Museveni, "We are being told that only a thin piece of rubber stands between us and the death of our Continent...they (condoms) cannot become the main means of stemming the tide of AIDS." To encourage children to use condoms is to admit that you have no faith in the ability of human beings to make correct choices, once they are equipped with the right information. The young people of Uganda have proved that people, even young people, can make correct choices, because the greatest reduction in the number of infections has occurred among the age group of 15 to 25 years, and this reduction occurred in the period before the onslaught of the condom campaign in Uganda.
Distinguished ladies and gentlemen, I wish to end by saying that it is not easy; the right way is usually the hard way. Uganda is not yet out of the woods, but, at least, we have proved that it is possible for people, especially young people, to change their behavior. We believe we have saved, or salvaged, generations of our young people, and the discipline we have instilled in them will stand them in good stead in other situations in the future. We have started a culture of respect for human life and the values that preserve life.
As for the nation itself, we are learning great lessons out of this bleak situation. One of the lessons is that our people, even the elderly and the poor, are not helpless once they are shown the way. We thank you, our friends in the international community who believed in us enough to be patient while we went against the current and tried out strategies that looked unpractical two decades ago. We value your support and respect, and we need your continued partnership as we continue to combat HIV, poverty and many other issues of under development.
My humble reminder to this august gathering, and to all leaders worldwide, is that health is more than just the absence of disease. It is the well-being of the totality of the human being. If the young person is encouraged to use the condom and develops a careless lifestyle, that young person will, sooner or later, pay with his young life, either through abuse of alcohol and drugs, or through some other unethical conduct. We must build a strong inner person in order to safeguard the health, and ultimately the life, of the outer physical person. And in this business, there is no shortcut.
May God give us wisdom in our various fields of endeavor.
Thank you for being so gracious in listening to me, and may God bless you all.
Janet K. Museveni. "Common Ground: A Shared Vision for Health." (June 17-19, 2004).
This address by Her Excellency Janet K. Museveni First Lady of the Republic of Uganda "Common Ground: A Shared Vision for Health" Conference Hosted by The Medical Institute for Sexual Health Washington, DC June 17- 19 2004