In Uganda, an AIDS Success Story Comes Undone

A new U.S.-financed survey found HIV increasing in Uganda during roughly the same period the country received more U.S. aid to fight the disease. The HIV infection rate there has grown from 6.4 percent in 2005 to 7.3 percent today, despite an influx of $1.7 billion from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).

HIV/AIDS rates are increasing both in urban and rural areas, and the infected are frequently husbands or wives, the Uganda AIDS Indicator Survey shows. HIV prevalence increases with wealth, rather than decreases, for both men and women.

"Something is not connecting properly," said Dr. Musa Bungudu, the UNAIDS chief in Uganda. "There are a lot of sociocultural issues that need to be addressed. These are harsh realities."

Successful HIV programs, including grass-roots efforts aimed at reducing Ugandans' numbers of sex partners, had helped cut infection rates in the 1990s. In 2003, PEPFAR partnered with faith-based groups and emphasized the "ABC" approach: Abstinence, Being faithful (monogamy), and using Condoms "for those most at risk."

Survey findings, based on detailed reports from more than 20,000 Ugandans across the country, include:

• 90 percent know fidelity in marriage is important for health, but about 25 percent of married men have multiple sex partners.
• 75 percent are knowledgeable about condom use, but fewer than 8 percent of married men with outside partners use condoms.

"If you have an environment that stigmatizes them, then don't expect people to use condoms," said Canon Gideon Byamugisha, a religious leader and AIDS activist.

Uganda also takes a hard line against homosexuality, which is illegal there. In one report, one-third of Ugandan men who have sex with men said they had married and fathered children; less than half used condoms.

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