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X. Conclusion

As an activist and woman living with AIDS, it makes me feel judged.  You are supposed to abstain and be faithful.  Condoms are only for those who are promiscuous.  I got HIV in marriage.  I was faithful in my relationship.  The battle to come out and be open was a struggle.  Now, instead of moving forward, we are moving strides back.
—Ugandan woman living with AIDS

Uganda is unique among African nations for its early and high-level leadership against HIV/AIDS.  The government’s willingness to address HIV/AIDS openly and break taboos surrounding sexually transmitted diseases is widely acknowledged as the cornerstone of its early success against the epidemic.  By involving a wide range of nongovernmental organizations in the AIDS struggle and allowing candid messages about sex to reach a wide audience, Uganda achieved high levels of awareness of HIV, increased voluntary HIV testing, and ultimately fewer new HIV infections.

Today, this progress may unravel as U.S.-funded organizations scale up programs that promote sexual abstinence and fidelity within heterosexual marriage to the exclusion of all other HIV prevention strategies.  These programs deprive young people of information that could save their lives.  They mock the plight of countless Ugandan women and girls who abstain until marriage and are faithful within it but nevertheless become infected with HIV.  They provide scant information or assistance to those at highest risk of HIV infection, including street children who trade sex for survival, children affected by conflict, and lesbian, gay, bisexual, and transgender youth.  They distort factual information about condoms and safer sex strategies, placing young people at a higher risk of HIV and other sexually transmitted diseases.

As their proponents admit, abstinence-only programs are not simply about preventing HIV/AIDS, but about promoting moral values.  However, censoring or distorting factual information about HIV/AIDS is not a moral value.  Moreover, casting HIV/AIDS as a “moral” disease that results from “promiscuity”—as abstinence-only programs invariably do—reinforces the deadly stigma associated with HIV/AIDS.  Throughout the 1990s, Uganda stood for the idea that AIDS could affect anyone, not simply “promiscuous” people.  This idea proved critical to respecting the human rights of people living with AIDS and protecting them from violence and discrimination.  Now, abstinence-only programs give Ugandans a new reason to stigmatize people living with AIDS and to judge their actions as immoral or blameworthy.

To its credit, Uganda continues to recognize that its young people face a high risk of HIV infection and has faced up to that challenge by expanding school-based sex education programs.  However, as a perceived global leader in HIV prevention, Uganda is accountable to evidence and best practices in HIV prevention.  The country’s high-profile U-turn toward unproven HIV prevention strategies for young people has, at this writing, already begun to resonate throughout other parts of Africa.  Its complicity in the rewriting of history around its HIV prevention “success” could have implications on HIV prevention programs for years to come.  Ultimately, it is not just Ugandans who will pay the price for the country’s back-steps in HIV prevention.  It is the entire effort against the global AIDS pandemic.

<<previous  |  index  |  next>>March 2005