Uganda and Malawi Offer Opposite Lessons for AIDS

HIV prevention and treatment efforts in small, poor Malawi offer a model for other African nations and a contrast to the cautionary tale of Uganda, a large and relatively prosperous county struggling with an alarming rise in infections.

During her eight-nation tour of Africa, Secretary of State Hillary Rodham Clinton visited both Uganda and Malawi. Speaking at an HIV/AIDS clinic in the Ugandan capital of Kampala, she said, "I am here because I am worried. Uganda is now the only country in sub-Saharan Africa where the rate is going up instead of down," referring to the country's doubling of HIV cases between 2004 and 2011.

Uganda has been widely praised for its AIDS-fighting efforts, which focused on prevention and treatment. More than $1.6 billion in U.S. assistance during the past six years has helped even very poor Ugandans access antiretroviral drugs and live normal lives. But the unintended consequences have resulted in a reduced perception of risk and made a positive diagnosis a route to access badly needed general medical care, say AIDS advocates.

Another explanation is a more socially and religiously conservative approach taken by President Yoweri Museveni's government. A proposed bill further criminalizing homosexuality would stall HIV prevention efforts by driving risky gay sex underground, advocates say.

In Malawi, where the per capita income is around $900, U.S. officials estimate one in 10 people have HIV/AIDS. However, the rate has dropped from 13 percent over five years. Innovative prevention and treatment programs are found throughout the country and have the support of President Joyce Banda. Malawi has cut mother-to-child HIV transmission; condom use is widely accepted; and a male circumcision program, once thought to be incompatible with traditional culture, is currently overwhelmed by requests.

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