Uganda, Abstinence and the Spread of HIV Doctors, philanthropists and community activists meet at the International AIDS conference in Toronto, Canada, to discuss ways to fight the spread of the disease. A central topic is Uganda, whose HIV-prevention work has been held up as a model for other countries. But health workers say the Bush administration's emphasis on abstinence over condoms has hurt Uganda.
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Uganda, Abstinence and the Spread of HIV

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Uganda, Abstinence and the Spread of HIV

Uganda, Abstinence and the Spread of HIV

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This is DAY TO DAY. I'm Madeleine Brand.


And I'm Alex Chadwick. The 16th International AIDS Conference is underway in Toronto. A principle topic again, AIDS prevention.

BRAND: The East African nation of Uganda has a prevention program that's considered a model for other countries. It's called the ABC approach - abstain, be faithful, or use a condom. The United States says ABC has led to a dramatic drop in AIDS infections in Uganda during the 1990s.

CHADWICK: But in recent years, health workers say the Bush administration's emphasis on abstinence over condom use has hurt Uganda's AIDS fight.

Fred de Sam Lazaro of Twin Cities Public Television went to Uganda for this report.


For two decades, ABC has been the heart of a comprehensive campaign in Uganda through the media, through dance and drama groups like this one at the AIDS Service Organization. It has encouraged candid talk about AIDS and compassion for those infected.

(Soundbite of singing)

LAZARO: In just over a decade, a key measure, HIV prevalence among pregnant women, dropped from 30 percent to 6.5 percent by the early 2000s. Uganda's achievement won praise and more international aid.

President GEORGE W. BUSH: And finally, Mr. President, you have been a world leader, not just a leader on the continent of Africa, but a world leader in the fight against HIV/AIDS.

LAZARO: President Bush visited in 2003 and praised his Ugandan host Yoweri Museveni. Bush cited ABC as a model as he increased U.S. AIDS assistance to African countries that year. But critics, including U.N. AIDS officials and the General Accountability Office of the U.S. Congress, say the added American money is a mixed blessing. That's because the U.S. now requires that a third of all AIDS prevention dollars be spent on abstinence programs. The number of such programs has grown.

Many are led by evangelical Christian groups modeled after American counterparts that lobbied for the abstinence requirement.

Unidentified Woman: I signed my abstinence pledge card.

LAZARO: At Uganda's largest university, young people gather regularly for rallies. They're asked to sign pledge cards that they'll abstain from sex until marriage. ABC means something different here.

A, abstinence, B, be faithful, and redefine the C to change company.

LAZARO: If condoms are mentioned at all, it's to question the morality or the effectiveness of using them, even though scientists say when they're used properly condoms do help contain the spread of HIV. Some advocates, even those based in churches, fear a program that's supposed to make no value judgments among abstinence, being faithful, or condoms, is beginning to stigmatize the C of ABC.

Pastor EDWARD BALIGANZAKI (AIDS Counselor, Kampala): I had one problem one time with one of the pastors, who said condoms are for the condemned. Condoms for the condemned, but for the righteous it is A-B.

Pastor Edward Baliganzaki counsels people at his Kampala church. He says some of them will simply not be able to abstain. With condoms becoming less socially acceptable and less freely available, he fears there'll be more unprotected sex and more HIV infections.

Pastor BALIGANZAKI: We are talking about young people who are having a body, who have feelings. We are bound to lose the war the moment we turn physical health issues into moral issues.

LAZARO: But to abstinence educators, moral issues are paramount.

Mr. STEPHEN LANGA (Director, Family Life Network): You see today, this word here, morality, is a word that is not politically correct.

LAZARO: Stephen Langa heads a group called the Family Life Network, which conducts abstinence workshops for youth and teachers.

Mr. LANGA: The minute you say the word morality (unintelligible) now you're judgmental. Now, you see, morality is what separates us from dogs and cows. We are working towards the restoration of family values and morals in our society.

LAZARO: Langa says studies show casual sex has declined, that the age of first sexual encounter has on average gone up from 14 to 17 years, all favorable trends he attributes to improved morality.

Uganda's Health Ministry insists ABC is even-handed, but statements from President Museveni and First Lady Janet Museveni - a devout evangelical Christian - seem to leave no doubt of a conservative leaning. At the 2004 World AIDS Conference in Thailand, the president credited abstinence and marital fidelity for his country's success. Condoms, he seemed to call, a necessary evil.

President YOWERI MUSEVENI (Uganda): I look at the condom as an improvisation, not a solution, an improvisation.

LAZARO: To some observers, it's a sharp reversal from Museveni's leadership earlier on.

Ms. BEATRICE WARE (AIDS Activist): I think Uganda is simply trying to be politically correct, to say what would please Bush.

LAZARO: Beatrice Ware became an AIDS activist after getting HIV from her husband. She says the American inspired abstinence campaigns do not protect women, many live in dire poverty, some in war zones where selling sex is a matter of survival. Being faithful doesn't protect women, she adds, noting that 40 percent of newly infected Ugandans today are married.

Ms. WARE: We know that for most women now marriage is not a safety net, that infections in marriage are on the increase. And we also know from, again, evidence based from research that for women negotiating safer sex is really a big challenge. And however faithful you might be, like I was, you cannot control the sexual behavior of your husband.

LAZARO: For their part, U.S officials here acknowledge there may be more emphasis on abstinence. But Dr. Jonathan Mermin, of the Centers for Disease Control and Prevention, says there's also more U.S. assistance in total, meaning he insists more condoms.

DR. JONATHAN MERMIN (Centers for Disease Control): The U.S. activities have tended to be expansive from the very beginning. We now have increased activities with youth, increased activities with faith-based organizations, increased activities with indigenous, nongovernmental organizations. So there's a chance to infuse all of these activities with an ABC approach.

LAZARO: One part of the Bush plan that everyone praises is treatment. Thirty-eight thousand Ugandans now receive life-extending antiretroviral drugs with U.S. funds. A similar number get them through other international donors.

But when it comes to prevention, there are worrying signs. After its steep decline, the HIV prevalence rate has stayed stubbornly plateaued at around 6.5 percent. About one million people, four percent of Uganda's entire population, are HIV positive.

For NPR News, this is Fred De Sam Lazaro.

BRAND: Stay with us, NPR News's DAY TO DAY continues.

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