As Ugandans infected, affected by or at immediate risk of HIV infection, we have watched with increasing disbelief as the governments of Uganda and the United States have undermined the comprehensive prevention strategies responsible for reducing the spread of HIV in Uganda since the first case was detected in 1982, seeking instead to replace these with ideologically-driven and scientifically discredited abstinence-only programs.
Uganda is known throughout the world for having dramatically slowed the spread of HIV in the 1990s through broad-based HIV prevention policies that simultaneously encouraged delay in sexual initiation among unmarried youth; faithfulness and monogamy among sexually active couples; and use of condoms by all sexually active persons living with or at risk of HIV infection. Central to this strategy were efforts to demystify HIV and reduce the silence and stigma surrounding both HIV infection and prevention technologies, such as condoms. As a result, many people changed their behavior, including through sharp increases in consistent and correct use of condoms. Objective scientific evaluations now show unequivocally that condoms played a critical role in reducing both the incidence and prevalence of HIV in Uganda.
Today, however, the historical record of Uganda’s success in reducing HIV is being distorted to further ideological agendas. Since 2003, we have watched as the Ugandan government downplays its own proven track record in an obvious attempt to please international donors such as the United States. We have watched as our own leaders rewrite history and misleadingly attribute reduced HIV prevalence to adoption of sexual abstinence. We have watched as the U.S. government pours millions of dollars into HIV-prevention programs that provide misleading information about the effectiveness of condoms and that fail to equip people—particularly women&$151;with the essential skills needed to negotiate safer sex. We have seen billboards throughout the city of Kampala, sponsored by the U.S. Agency for International Development (USAID), the Office of the First Lady of Uganda and the Global Fund to Fight AIDS, Tuberculosis and Malaria, that exaggerate the failure rate of condoms and present “abstinence-until-marriage” as a complete HIV-prevention strategy, despite the fact that a large share of women are getting infected within marriage. We have seen Ugandan organizations stop supplying condoms either to gain or to avoid losing U.S. funding.
Over the past year, access to condoms in Uganda has been reduced dramatically. In late 2004, the government of Uganda issued a nationwide recall of Engabu condoms claiming these were defective, and causing a catastrophic shortage of the only condoms previously made freely available in government health clinics. At the same time, the government placed onerous new taxes and quality-testing requirements on all condoms imported for social marketing and for sale on the private market. This in turn led to price increases of more than 500 percent for condoms imported for these purposes, effectively eliminating the only other sources of affordable condoms in the country.
Today, condoms are largely absent from public clinics, and the government has undermined public confidence in the effectiveness of condoms against HIV. At this writing, an estimated 34 million condoms have passed post-shipment quality tests but remain impounded in warehouses in Uganda because of the government’s failure to bring them to market. We are struck by the sudden shortage of free government and other subsidized condoms at a time when the government is collaborating with the United States to expand abstinence-only programs throughout Uganda. We do not believe this is coincidental.
We believe that the mismanagement of the Engabu recall, the ongoing delay in re-supplying public health facilities with free condoms, and the failure of the Ugandan government to launch an educational campaign to restore confidence in both the Engabu brand of condoms and condoms generally represent clear evidence of the government's involvement in campaigning against condom use.
We condemn the diversion of valuable HIV/AIDS funds away from programs that provide a full range of HIV-prevention options and toward those that focus exclusively on abstinence and fidelity for HIV-prevention. We believe such approaches are not only unrealistic and scientifically unsupportable, but also threaten the lives of millions sexually active adults and young people, including married people, sero-discordant couples, and women in polygamous marriages. We also believe that such programs may have other unintended consequences, such as reinforcing early marriage and child marriage in keeping with an obsession with virginity.
We further condemn the false morality under which these shifts are being made. At a time when public rhetoric about faith, religion, and morality is at a fever pitch, the dramatic shift toward abstinence-only programs needlessly threatens the lives of millions of Ugandans now at risk of HIV infection and re-infection.
We demand that the Ugandan government take the following urgent steps in order to prevent any further deterioration of its successful HIV-prevention policies:
1) RELEASE THE CONDOMS: The Government of Uganda should release all condoms in storage in Uganda—for sale or donation—by the end of September 2005.
2) LIFT THE TAX: Repeal recent taxes on imported condoms, and male branded condoms available at their previous prices, before the Engabu recall.
3) EDUCATE THE PEOPLE: Take concrete steps to restore public confidence in Engabu condoms and in the effectiveness of correct and consistent condom use as an HIV prevention strategy.
4) ELIMINATE ABSTINENCE-ONLY PROGRAMS: Shift funding for abstinence-only or abstinence-until-marriage programs to programs that provide comprehensive information about safer sex and the correct and consistent use of all available methods of HIV prevention, including male and female condoms; provide individuals and couples with the skills necessary to negotiate safe, consensual sex; and address the underlying conditions, such as gender-based violence, economic and social disparities and lack of basic human rights that leave so many women and girls vulnerable to HIV Infection.
5) PROBE THE RECALL: Investigate the steps leading up to the recall of Engabu condoms, and provide a public explanation for the ongoing condom shortage and for price increases.
6) FACE THE PUBLIC: Hold a public forum in which concerned individuals have an opportunity to confront high-level government officials with their concerns about the shortage of condoms and the evident shift toward ABSTINENCE-ONLY approaches.
7. INTENTION TO SUE: As citizens of this country we believe that the continued shortage of condoms is a violation of our right to access of essential health commodities. While our priority is dialogue, we shall not rule out use of legal means if government does release the condoms by end of September 2005.
We highly appreciate the time you will take to read and respond positively to our recommendations and we pledge our full support should the US government put undue pressure on you. We urge you to put national interest first.
C.c. Office of the President.
Committee of Social Services, Parliament of Uganda.
Committee on HIV/AIDS, Parliament of Uganda.
Uganda AIDS Commission.
Signed:
As of September 13, 2005, this letter had been signed by fifty-four Ugandans and endorsed by fifty-eight individuals or organizations outside Uganda. To sign this letter in solidarity with Ugandans, send your individual or organizational signature (including name, title, affiliation, and country of residence) to: heps@utlonline.co.ug.
