Uganda

Introduction

Background

Once referred to as the “Pearl of Africa” by Winston Churchill, Uganda lies in East Africa, bordered by Rwanda, the Democratic Republic of the Congo, Sudan, Tanzania and Kenya. The landlocked country is divided into 78 districts that are spread across four administrative regions — Northern, Eastern, Central and Western. The capital is Kampala.

There are myriad ethnic groups in Uganda, none of which is large enough to constitute a majority. Dozens of languages are spoken. While the official languages are Swahili and English, Swahili is not widely spoken.

The country gained independence from the United Kingdom in 1962. In 1971, Idi Amin took over in a military coup and ruled the country for the rest of the decade. Under his reign, nearly 300,000 Ugandans lost their lives and the economy plummeted when Amin forcibly removed minority Indian entrepreneurs from the country.

Amin was overthrown in 1979 by Tanzanian forces and Ugandan rebels. Milton Obote, who had preceded Amin as president, took over and ruled until 1985, when he was overthrown and replaced by a general who ruled for six months. The general was overthrown by the current president, Yoweri Museveni, who has been in power since 1986.

The face of HIV

According to the U.S. State Department’s Office of the U.S. Global AIDS Coordinator, the infection rate is 10.7 percent in urban populations and 6.4 percent in rural areas.

In 2006, the government banned HIV-positive recruits from joining the military, a move it called a “humanitarian” measure. The defense force has suffered from losing soldiers to AIDS.

Challenges to fighting the HIV epidemic

The northern part of Uganda is held by a rebel group called the Lord’s Resistance Army (LRA), headed by Joseph Kony, who claims he is a spirit medium and wants to create a society based on the Ten Commandments. The LRA has committed rape, torture, mutilation, and abduction of children, forcing girls to become domestic and sexual servants and boys, child soldiers.

The violence has caused 2 million people to flee their homes and spawned refugee camps. Violence and displacement are closely linked to HIV infection. According to AIDS activists, many women who contracted HIV through rape during the conflict are ignored or stigmatized.

The International Criminal Court has arrest warrants out for Kony and his followers, but to ensure their retreat into southern Sudan, some groups, such as the United Nations, are pushing for the warrants to be lifted. The LRA’s second-in-command, Vincent Otti, says the warrants must be dropped before the LRA would consider a peace settlement.

Ugandan government response

According to the World Health Organization (WHO), Uganda has demonstrated a “very high level of political commitment and awareness at all levels and a strong and comprehensive health sector response to HIV/AIDS that has become a model for many countries.” Its STD/AIDS Control Program, created in 1986, was the first program of its kind in sub-Saharan Africa.

In 1992, the government created the Uganda AIDS Commission to oversee the various HIV programs. Currently there are 13 HIV/AIDS programs in various government ministries and almost 2,000 nongovernmental and faith-based organizations working to curb the epidemic.

In 2000, the Ministry of Health created the National Committee on Access to Antiretroviral Therapy, and since 2004, the government has provided free antiretroviral drugs, according to the WHO.

Both the president and the first lady, Janet Museveni, are evangelical Christians and have very heavily pushed the “Abstinence” and “Be Faithful” components of the country’s Abstinence, Be Faithful, and correct and consistent Condom use, or so-called ABC, approach. In fact, the ABC approach originated in Uganda.

Museveni has said publicly that condoms are not without risks. Conservatives criticize those who support condom use as a means of preventing the spread of HIV.

A Ugandan HIV activist, Beatrice Were, who works for the Johannesburg-based ActionAid International, told ICIJ, “One of our newspapers said that people like myself who advocate for condoms are doing so because we want Ugandans to have ‘too much sex.'”

According to Were, the article further alleged that condom supporters “are selfish because we know that condoms cause disease, and because we are infected, we want all Ugandans to get infected.”

U.S. government response

In fiscal 2005, Uganda received $29.1 million for prevention activities, or 23.1 percent of the country’s total PEFPAR funding for prevention, care and treatment. Of that total, $6.5 million went toward condom-related programs. Another $43.3 million — or 34.3 percent — went to care, while treatment activities were allocated $53.6 million — or 42.6 percent.

Among the achievements PEPFAR claims for 2005: shipping 47 million condoms to Uganda and reaching more than 3.5 million people with condom and related prevention services; providing antiretroviral treatment for 67,500 adults and children (ARV drugs have largely transformed HIV/AIDS from a fatal condition to a manageable illness); increasing the number of outlets providing prevention of mother-to-child transmission services from 177 to 300 over the course of the year; and providing counseling and testing to more than 1 million people.