In 2001, Ugandan President Yoweri Museveni returned from the UN General Assembly Special Session (UNGASS) on HIV/AIDS with an ambitious task: to launch Uganda’s first nationwide school-based HIV-prevention curriculum. As an acknowledged “success story” in the fight against AIDS, Uganda has long grasped the importance of teaching its young people the basic facts of AIDS, and had designed a series of curricula in the 1990s that addressed basic issues of HIV/AIDS and reproductive health. But Museveni had something bigger and better in mind: he wanted to create an HIV/AIDS curriculum that would reach every single pupil in the country, from the well-heeled youth in urban Kampala to the thousands of neglected orphans in the country’s conflict-stricken north. He called the initiative PIASCY, the President’s Initiative on HIV/AIDS Strategy on Communication to Youth.

Within months, AIDS educators around the country were hard at work putting together an updated HIV/AIDS curriculum for the country’s estimated 14,000 primary schools. Not surprisingly, the process was controversial. Religious groups wanted to include information warning pupils against pornography and “provocative” dress, while sex educators wanted to address taboo subjects like masturbation and homosexuality. Eventually a compromise was reached, and in March 2003, President Museveni launched a set of teachers’ manuals for distribution to all of the nation’s primary schools. The manuals contained chapters on how HIV is transmitted, how to protect oneself from infection, and how to treat people with AIDS with dignity and respect. Since many Ugandan primary school pupils are in their mid to late teens, the manuals also contained basic information on the importance of safer sex, condom use, being faithful, and getting an HIV test. Finally, the manuals contained information on “life skills” like how to “say no” to sex, how to avoid sexual violence, and how to maintain good sexual hygiene.

Meanwhile, back in Washington, D.C., another Presidential initiative on HIV/AIDS was in the works: the President’s Emergency Plan for AIDS Relief, or PEPFAR. PEPFAR was also committed to expanding school-based HIV/AIDS education in developing countries, but it took a different approach. At the insistence of some members of the U.S. Congress, PEPFAR required that one-third of all HIV prevention spending go to “abstinence-until-marriage” programs, or those that teach sexual abstinence as the primary method of HIV-prevention. The preferred approach among U.S.-based evangelicals since the 1980s, abstinence-until-marriage programs omit information about condoms in the belief that safer sex messages encourage young people to be “promiscuous.” They focus on the idea that abstaining until marriage is the only “100 percent guaranteed” method of HIV prevention, promoting concepts such as “virginity pledges,” “secondary virginity” (for young people who have already had sex), and entering into “biblical marriage relationships.”

The U.S. government had been modestly supporting PIASCY in Uganda since before the launch of PEPFAR. But when the PIASCY manuals were released in March 2003, something strange occurred. Evangelical groups that had not been involved in the drafting of the materials began objecting to their content and actively blocking their distribution. One objector argued that a diagram of a penis with a condom on it would start encouraging young people to have sex. Other groups insisted on a new chapter on “ethics and morals,” in which young people would be taught to prevent HIV through “moral” conduct. “It got nastier and nastier,” said an AIDS educator who observed the entire process. “Everywhere the [PIASCY] manual said, “There will be some children who have sex,’ they crossed it out and said, ‘They should be told to stop.’” After increasing pressure, the PIASCY materials were pulled from circulation and sent back to the drawing board.

Officials at USAID, which has been funding PIASCY almost since the beginning, deny that PIASCY is “externally driven” and blame the controversy on “local factors.” Still, it seems unlikely that the U.S. government’s high-profile embrace of “abstinence-until-marriage” approaches did not influence the local religious groups. Moreover, the most vocal supporters of abstinence-until-marriage approaches in Uganda – First Lady Janet Museveni and Pastor Martin Ssempa of the Makerere Community Church – are known to have close ties to U.S. evangelical churches and conservative members of the U.S. Congress. Even President Museveni himself, traditionally a supporter of comprehensive HIV prevention approaches, began making statements in 2004 objecting to the prominent role of condoms in national HIV prevention campaigns – statements many attribute to the U.S. government’s new-found support for abstinence-only approaches along with their continuing support for his government.

In response to the objections of religious groups, USAID convened a series of “stakeholder meetings” in late 2003 to revise the PIASCY materials. Organized by the AIDS/HIV Integrated Model District Program (AIM), the meetings included numerous groups that had not been involved in the initial drafting, including the Association of Women Religious in Uganda, the Baptist Church, and the Uganda Orthodox Church. Other faith-based organizations, such as the Church of Uganda and the Uganda Catholic Secretariat, had been involved in the initial drafting. USAID also placed a technical adviser at the Uganda Ministry of Education to oversee the content of the curricula and coordinate the program. According to one ministry official, an AIM employee instructed the ministry that it would be necessary to revise the materials to make them acceptable to everyone, and that based on that employee’s experience, parents would not accept a book that was too graphic or explicit.

By the end of the stakeholder meetings, a new version of PIASCY was ready for circulation. The new version placed a strong emphasis on sexual abstinence, instructing teachers to “explain (to pupils) that sex or sexual intercourse is what grown-up married people do when they love each other in marriage.” It also added a new chapter entitled, “Ethics, Morals and Cultural Values,” in which the following message appears:

  • The religious teachings in Uganda all agree about the values of life, family and sex.
  • They all promote the understanding of sex as a gift from God that must be protected and respected.
  • They discourage sex outside marriage. In fact, religions consider sex outside marriage as sinful and dishonoring God, the creator.
  • HIV/AIDS enters the human body mostly though sex. Young people, therefore, should learn to value life, respect sex and avoid HIV/AIDS.

In addition to these religious teachings, the new PIASCY materials omitted information about condoms and safer sex that had appeared in the original versions. Diagrams depicting condoms, safer sex, puberty, and genital hygiene were purged. The final materials omitted the statement that “condoms will be an important part of your protection plan when you start having sex when you are older,” replacing them with statements such as “pre-marital sex is risky” and “for pupils, sex leads to great sadness.” They also stated that premarital sex and homosexuality “violate religious or cultural moral standards” and are considered “immoral.” One teachers’ manual for older primary pupils preserved some information about condoms, stating that “used consistently and correctly, condoms protect against HIV/STIs and pregnancy.”

In November 2004, Human Rights Watch conducted an investigation in Uganda to monitor the implementation of PIASCY and other HIV-prevention programs in Uganda. The new PIASCY materials had just been released the previous February, and USAID had hired the Uganda Program for Human and Holistic Development (UPHOLD) to train 40,000 teachers on the content of the curriculum. In numerous interviews, teachers said that UPHOLD trainers had instructed them not to discuss condoms with their upper primary students, because PIASCY was an “abstinence-only” curriculum. One teacher said, “At the PIASCY training, we were told not to show (pupils) how to use condoms and not to talk about them at our school. In the past, we used to show them to our upper primary classes. Now we can’t do that.” Another commented that President Museveni had recently begun to criticize condoms. “President Museveni said there is no use teaching young people about condom use,” he said, “because then children will go and experiment with them.” Some teachers said they taught their pupils about condoms anyway because, as one put it, “people don’t buy this idea of abstinence, because in Uganda, many girls are using sex to buy their daily bread.”

Whether young Ugandans end up receiving adequate HIV/AIDS information from PIASCY may depend on how individual teachers choose to implement the program. What is noteworthy, however, is how a curriculum that began as a comprehensive HIV-prevention program morphed into an “abstinence-until-marriage” program almost overnight. The U.S. government may deny responsibility for this short, or accuse its critics of not respecting the priorities of Ugandans. But these denials increasingly lack credibility in the face of increased U.S. support for abstinence-only approaches. In 2004, the United States budgeted $8 million for abstinence-until-marriage programs in Uganda alone. U.S.-funded agencies such as Population Services International, formerly the most prominent marketer of condoms in Uganda, are now visibly sponsoring billboards promoting “abstinence until marriage.” Abstinence-only promoters, including First Lady Janet Museveni and Pastor Martin Ssempa, are now receiving considerable financial or moral support from Washington. In this climate, it is no wonder that religious organizations in Uganda won the day in the battle over PIASCY. The real tragedy is that if ineffective abstinence-only programs prevail in Uganda, the only victor will be HIV/AIDS.