Yoweri Museveni

Technology and G8 funding have given the continent its best chance yet of combating its number one killer. The numbers are impossible to digest. Three million people a year die from the disease, most sufferers contract it two or three times a year and, whenever they do, are so struck down that they can neither work nor tend to their families for several weeks at a time. So if 2005 was the year of Africa, what happened to malaria?

KAMPALA, 14 September - A six-man commission has opened its inquiry into allegations of mismanagement of Uganda's anti-AIDS programme and will hold public hearings, officials said on Tuesday.

A former World Health Organization researcher has said Uganda's ABC strategy to combat HIV/AIDS --Abstinence, Be faithful, use Condoms, in that order -- could cut HIV infections by 80 percent if expanded across Africa, according to a feature in today's Washington Times. International aid workers have rebuffed the policy, calling it a cover for a right-wing agenda. Since Uganda launched the strategy in 1986, HIV/AIDS rates there have steadily declined, while infection rates in much of the rest of Africa have skyrocketed. Under the program, HIV prevalence among pregnant women -- a common yardstick for assessing HIV transmission in a population -- dropped in Uganda from 21 percent in 1991 to 6 percent in 2001. Some experts said the key to the program's success has been in changing Ugandans' sexual behavior by focusing on sexual fidelity, something international aid workers reportedly were doubtful about. According to epidemiological data, the focus on faithfulness may be the most important ingredient in the overall program's success. Women had to take responsibility for their own lives, said Sophia Mukasa Monico, a Ugandan who is a senior AIDS program officer for the Global Health Council. Wives told their husbands to be faithful, use a condom, even in marriage, or there would be no sex. Many women in Uganda had celibate marriages or moved out on their own, she said, adding that today, 60 percent of Ugandan women live on their own or are self-sufficient. The number of men reporting two or more sexual partners plummeted from more than 70 percent in 1989 to 15-20 percent in 1995. Among women, that figure dropped from 18 percent in 1989 to 2.5 percent last year. According to the Washington Times, Ugandan President Yoweri Museveni began the program after almost one-third of his top military officers tested positive for the virus during a trip to Cuba in 1986. Later that year, Cuban President Fidel Castro reportedly took Museveni aside and told him, Brother, you've got a problem. Uganda mobilised as if it were World War III, said Elaine Murphy, a global health specialist at George Washington University. They did this without donor money, on their own. At the time, the AIDS establishment laughed at him. ... But Museveni was right, said Norman Hearst, an epidemiologist at the University of California, San Francisco. I've had people tell me that the only reason they were successful in Uganda is that there were no European or American experts there. A more common international approach that relies heavily on condom distribution has been deemed largely a failure by some. There really is not any clear evidence that condom promotion by itself has been able to roll back the AIDS epidemic in any country where there is widespread transmission, Hearst said. The historical approach to HIV has been little A, little B and big C. The public health community at large did not believe in abstinence, but Africans were far ahead of the worldwide public health community on this, said Anne Peterson, a U.S. Agency for International Development global HIV/AIDS official. The core of Uganda's success story is big A, big B and little C. But U.S. HIV/AIDS workers have reportedly been reluctant to implement ABC-style programs, which have been endorsed by President George W. Bush and many faith-based organizations, for fear ABC is a cover for an abstinence-only policy. Hearst said that those who oppose ABC are just as religious in their beliefs as missionaries, and no more constructive. They are willing to let Africans die rather than embrace something that goes against their way of life. The Washington Times reports that ABC may be gaining more acceptance. ABC programs launched in Senegal and Zambia are reportedly showing positive results, and AID in December embraced ABC. Thinking people have to ask the question, 'What works? What saves lives?' said Murphy (Source: Washington Times, March 13).

A leading scientific journal, The Lancet, has questioned Uganda's HIV/AIDS success story, saying that it is based on flimsy evidence. Despite being widely regarded by the international community as having very successfully lowered the rates of HIV/AIDS, the basis for the Ugandan claim of success has rarely been critically investigated, wrote Justin Parkhurst of the London School of Hygiene and Tropical Medicine, in an article published last month. President Yoweri Museveni announced in June that rates of HIV infection were down to 6.1 percent this year from 30 percent in 1990, The New Vision Ugandan state-owned newspaper reported. Parkhurst says that selective information has been used to compile such official figures. Statements of success have often been based on misinterpretation of epidemiological data, and can sometimes not be supported when all the Ugandan evidence is assessed. While he commended Uganda on being the first African nation to establish a national response to HIV/AIDS, and on successfully lowering rates of infection, he said information from a small number of urban antenatal clinics - hardly indicative of the whole of Uganda where about 87 percent of the population lived in rural areas - appeared to be the basis for the statistics, and was therefore not representative. Unfounded claims of Ugandan success have persisted in international policy discourse, he noted. Furthermore, claims that the rates of infection had decreased were at times based on the rate of prevalence - as opposed to the rates of infection per year - which can be distorted significantly due to the number of people dying each year. Successful HIV-1 prevention cannot be claimed until a decrease in the number of new infections which each year (measured as incidence) occurs, he said, adding that the term HIV rate was used ambiguously by many people. Another frequent mistake, he said, was the notion that the decline in prevalence was due to a few specific interventions by the Ugandan government. He emphasised that the government was but one player - among numerous NGOs, church groups, community activists - in the fight against the virus. These claims have sparked a row in Uganda, with officials vehemently denying them. Minister of State for Health, Mike Mukula, and Minister of State for General Duties in the Prime Minister's Office Mondo Kagonyera told parliament on Wednesday that there was no reason to doubt the president's figures, because they were the result of scientific research, The New Vision reported. But Parkhurst insists that the standards of proof for policy recommendations seem to have been lowered to provide the international community with the African success story it wanted, or even needs. Parkhurst suggested that pressure to produce results may have resulted from donor fatigue - a lack of willingness to fund unsuccessful projects - combined with an overall reduction in funding available to Africa. Similarly, he noted, low morale among health workers could be boosted by a success story.

A conference attended by Uganda's President Yoweri Museveni in Kampala Monday saw the launch of the first African AIDS centre for training doctors treating AIDS patients with modern antiretroviral (ARV) drugs. The centre at a state university medical school near Kampala is the brainchild of the Academic Alliance for AIDS Care and Prevention in Africa, an organisation founded last year by American, Ugandan and Canadian scientists. According to co-founder Dr. Tom Quinn, the centre will train African doctors on how to best utilize and monitor the use of ARV drugs. It will boast a state-of-the-art laboratory for diagnosing HIV and will provide care for AIDS sufferers, Quinn told the Deutsche Presse-Agentur (DPA) Monday. Uganda is one of the countries worst affected by the global AIDS epidemic, despite running one of Africa's most aggressive AIDS control programmes. Ugandans comprise 1.2 million of the 25 million Africans infected with the HIV virus. The East African state has lost 800 000 citizens to AIDS since 1983, resulting in one million orphans. The new centre is to be built by the US-based Pfizer Foundation, a division of leading pharmaceutical company Pfizer Inc, which will also provide ARV drugs to the facility. Pfizer will initially provide the drugs free of charge, later at low prices. The facility, which will handle no more than 50 000 patients, is scheduled to open early next year, expanding subsequently to neighbouring states and other locations in Africa. (Source: SAPA-DPA, 11 June 2001)