Tuesday, March 01, 2005

Uganda and HIV prevention: A couple of years ago an interesting article published in The New Republic argued for the promotion of abstinence in Africa to fight AIDS. The logic behind stressing abstinence and fidelity, rather than condom use, was that a campaign largely based on these themes in Uganda seems to have been largely sucessful in bringing down HIV rates. Christian conservatives quickly caught on, hosting Ugandan politicians and conferences; the Ugandan president was invited to the White House; but world health organizations and NGO's remain (unjustifiably?) skeptical.

At the time I thought the piece was intriguing, but a bit oversold. Uganda ran its campaign under the slogan "ABC," meaning "Abstain, Be Faithful, or wear a Condom." Its unclear that we can simply rule out condoms and credit A and B for success. Anyway, since controlled experiments have in the past shown that efforts to advocate faithfulness/abstinence tend to be unsuccessful, the success of such a campaign in Uganda would be surprising.

Now we have the solution to the puzzle. A study that followed 10,000 people over 10 years in Uganda reveals that in fact abstinence and faithfulness have decreased over the period of the ABC campaign; by contrast, condom use has increased. This result jibes much better with previous studies of these techniques in fighting HIV.

There are still puzzles here to be sorted out. One reason why HIV rates are so high in Africa is lower condom usage. Why did men in Uganda use condoms at such high rates, relative to their neighbours? Was it the ABC campaign? If so, why did similar campaigns elsewhere - that places more stress on condoms - fail?


At 2:18 PM, Blogger angela said...

the thing with condoms is that generally education on how they work didnt explain the most basic principles of condom use. some people even thought they were reusable. i think uganda giving people three options really established the message that one of those three things really has to be followed.


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