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II. Recommendations

To the Government of Uganda

  • Replace programs that promote abstinence-until-marriage to the exclusion of other effective HIV prevention strategies.  Use instead comprehensive programs that provide complete, factual, and unbiased information about HIV prevention, including information about the correct and consistent use of condoms.  Encourage bilateral donors to redirect funding away from abstinence-until-marriage programs towards comprehensive programs.  Until such time as abstinence-until-marriage programs can be replaced, ensure that nothing in these programs undermines effective strategies for HIV prevention.
  • Integrate the draft “Abstinence and Being Faithful (AB)” policy into existing HIV prevention strategies to avoid any conflict between them.  Remove any information from the policy that suggests that teaching young people about safer sex contradicts, confuses, or undermines the message of abstinence.  Recognize in all HIV prevention programs and policy documents that marriage does not provide a guarantee of safety against HIV. 
  • Rescind the recommendation of compulsory HIV testing for couples intending to marry found in the AB policy.  Consistent with public health and human rights standards, encourage instead universal access to voluntary HIV testing and counseling.
  • In school-based programs, ensure that school teachers are adequately informed about the prevalence of sexual activity among young Ugandans and qualified to provide objective, unbiased HIV prevention information and counseling to sexually active pupils and students.  Ensure that such messages (including about condoms) are not contradicted by political leaders.  Take steps to supplement HIV prevention messages given in school assemblies with in-class lessons and activities promoting assertiveness, self esteem, and other life skills outlined in the school curricula.  Involve pupils and students in the implementation of school-based HIV prevention programs and the evaluation of materials. 
  • For secondary school HIV prevention materials, ensure scientific accuracy and age-appropriate HIV prevention information, in addition to messages of abstinence.  Remove references to non-marital sex as a form of deviance.  Ensure that materials also assist young people who cannot legally or who do not marry, including lesbian, gay, bisexual, and transgender youth.  Finalize curricular materials and take measures to avoid granting effective veto power to any particular religious or political point of view.
  • Ensure that HIV prevention programs conducted out-of-school provide complete, science-based information.  Enforce a requirement of scientific accuracy for the delivery of all HIV prevention information, whether by secular or faith-based organizations.  Enact a clear policy opposing human rights violations against grantees or sub-grantees of HIV prevention funds, including “virgin censuses,” discrimination against lesbian, gay, bisexual, and transgender youth, and discrimination against those who hold opposing religious views.
  • Ensure that the special needs of vulnerable populations, including orphans and children affected by AIDS, internally displaced persons, street children, and lesbian, gay, bisexual, and transgender persons, are explicitly recognized in national and local HIV prevention policies and programs.  Recognize the inherent limitations of abstinence-until-marriage messages for these populations and withdraw support from these programs accordingly.
  • To reduce women’s vulnerability to HIV/AIDS, enact and enforce laws that protect women and girls from violence and discrimination.  These include laws that criminalize marital rape and that guarantee women’s equal property rights.  Ratify the protocol on women’s rights under the African Charter on Human and People’s Rights.
  • Recognize the link between the spread of HIV/AIDS and discrimination based on sexual orientation, including the criminalization of same-sex relations.  Repeal sections 140, 141, and 143 of the Penal Code which criminalize same-sex relations between consenting adults and are sometimes used as a justification for failing to provide life-saving HIV prevention information and services to lesbian, gay, bisexual, and transgender youth. 
  • Take urgent steps to ensure an adequate supply of free and low-cost condoms in Uganda to assist HIV prevention efforts.  In light of the recent recall of government-funded condoms due to apparent quality control problems, urgently seek relief from international donors to fill the condom supply gap.  Make publicly available all information about the condom recall, the steps the government is taking to address it, and how the public can obtain free condoms in the interim.  Consistent with the National Condom Policy and Strategy (2004), ensure that all sexually active or potentially sexually active individuals, not just select populations, are targeted by condom promotion campaigns.

To the Government of the United States

To the U.S. Congress

  • Repeal sections 402(b)(3) and 403(a) of the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act.   These provisions require the expenditure of 33 percent of HIV prevention funds on abstinence-until-marriage programs that exclude consideration of other approaches to HIV prevention.  In light of existing government-funded evaluations showing abstinence-only programs to be ineffective and potentially life-threatening, enact legislation prohibiting the expenditure of federal funds on these programs pending further research and evaluation. 
  • Redirect U.S. funding for abstinence-until-marriage programs to proven interventions that guarantee young people complete information about HIV prevention, including the use of condoms.  Encourage the U.S. Office of the Global AIDS Coordinator to revise sections of the U.S. global AIDS policy that make false claims about the effectiveness of abstinence-only programs and promote abstinence-until-marriage as an HIV prevention strategy for young people.  Ensure that age-appropriate information about condoms and condom promotion strategies are provided to all youth and not limited to “high-risk” populations.
  • Request and publicly disclose information from the global AIDS office about all international funding for abstinence-until-marriage programs.  Include regional and national-level funding as well as grantees and sub-grantees.  Enforce policies prohibiting the use of U.S. federal funds for religious proselytizing, political purposes, or the provision of medically inaccurate information.  Ensure that all HIV prevention programs for youth are evaluated according to their short and long-term impact on young people’s sexual knowledge, attitudes, intentions, and behaviors, as well as trends in HIV transmission, and make these evaluations public.
  • Request and publicly disclose information from the global AIDS office about all international funding for HIV prevention programs for young people other than abstinence-until-marriage programs.  These include programs that combine abstinence messages with factual information about condom use and safer sex, seek to enhance women’s sexual autonomy and empower them to refuse sex and insist on fidelity or condom use, and/or address human rights violations that increase women’s vulnerability to HIV/AIDS, including in marriage.

To the Presidential Emergency Plan for AIDS Relief (PEPFAR) country team in Uganda

  • Urge the removal of any scientifically inaccurate information from HIV prevention materials in Ugandan secondary schools.  Withhold any funding for materials that provide false or misleading information, and support the publication of texts that contain complete and science-based HIV prevention messages.  End support for HIV prevention materials, programs, or organizations that present heterosexual marriage as the sole legitimate context for sex or that directly or indirectly present marriage as providing safety from HIV infection.
  • Evaluate the provision of HIV prevention messages in schools, with particular attention to whether teachers are censoring sensitive information contained in approved texts.  Encourage political leaders not to contradict information in school materials.  Ensure that U.S.-funded training programs do not discourage teachers from discussing condoms or otherwise promote an abstinence-only agenda.  In U.S.-funded training sessions, remind teachers to answer all students’ questions about safer sex and condom use, as stipulated in approved texts.    
  • Evaluate the impact of U.S.-funded HIV prevention programs for Ugandan youth.  Include an evaluation of whether these programs affect young people’s knowledge, attitudes, intentions, and behaviors related to sexual activity.  Review existing programs to ensure that no HIV prevention money is being used for reasons other than intended, and investigate any misuse of HIV prevention funds, such as for partisan political activities, religious proselytizing, or virginity testing.  Withhold support from projects that so misuse HIV prevention funds. 
  • Take immediate steps to counter all misinformation about condoms, including by government and private actors.  Withhold funds from organizations that make false or misleading statements about condoms or actively discourage them as an HIV prevention strategy.  Together with other donor governments, immediately import a sufficient number of condoms to ensure an adequate supply for free condoms until such time as safe and tested condoms are available through the national distribution program.

To the Office of the Global AIDS coordinator (OGAC) of the U.S. government

  • Provide a full accounting of existing funding for youth HIV prevention programs.  This should include programs administered regionally through Track 1.0 and in national programs through Track 2.0 of PEPFAR.  Withhold funding from any grantee or sub-grantee that uses U.S. HIV prevention funds to provide false or misleading scientific information, engage in religious proselytizing, engage in partisan political activity, or discriminate against individuals based on their sexual orientation.
  • Cooperate with requests by individuals or government agencies to make publicly available all information on abstinence-until-marriage programs.  Provide information about national and regional funding for these programs, grantees and sub-grantees, and details about their activities.  Establish a public mechanism for monitoring the effectiveness of HIV prevention programs, and include a wide range of civil society groups in this process.

To all other donors to Ugandan AIDS programs, including the Global Fund and U.N. agencies

  • Review existing HIV prevention programs in Uganda.  Ensure that funding is not provided to individuals or groups that deny young people factual information about HIV prevention, discriminate against marginalized communities such as sexual minorities, or use HIV prevention funds to engage in religious proselytizing. 
  • Develop a public position on U.S.-funded abstinence-until-marriage programs.  Evaluate the impact of these programs on the availability of effective interventions such as comprehensive sex education, life skills programs that emphasize girls’ empowerment and negotiation skills, and programs that address HIV risk among especially vulnerable communities.  Evaluate the feasibility of compensating for this loss through increased funding and technical support to proven interventions.
  • To reduce women’s vulnerability to HIV/AIDS, support legal reforms that protect women and girls from violence and discrimination.  Reforms should include protections against marital rape and unequal access to property.  Support programs that promote women and girls’ sexual autonomy and economic empowerment, including job training and credit programs.
  • Work with the government of Uganda to address the current condom supply shortage.  Together with other donors, immediately provide a sufficient number of condoms to cover the current shortage until such time as safe and tested condoms are available through the national distribution program.

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