January 25, 2013
The U.S. non-governmental organization AIDS Healthcare Foundation (AHF) has launched a controversial HIV prevention campaign in Uganda, urging married people and individuals in long-term relationships to use a condom if they cheat, and to have an HIV test if they think their partner has cheated on them. The Uganda AIDS Commission (UAC), the government agency in charge of HIV/AIDS efforts, disagrees with the AHF campaign messages and has directed AHF to remove the billboards. UAC's official policy recommends "Abstinence, Being faithful, and consistent, correct Condom use" (ABC) in combination with biomedical interventions. Studies estimate that 43 percent of new HIV infections in Uganda occur among couples in long-term relationships.
Uganda attributed its early success in reducing HIV to the ABC policy. HIV prevalence in the early 1990s was 18 percent, compared to six percent in 2000. However, the AIDS Indicator survey reports that HIV prevalence reached7.3 percent in 2011. Critics of UAC policy state that the Ugandan government has given into pressure from the President's Emergency Plan for AIDS Relief, which emphasizes abstinence and fidelity over condom use.
Research indicates that UAC's traditional messages urging couples to be faithful and get tested can reduce unprotected sex, but prevention interventions also need to address "same-sex couples, adolescents, and young people in relationships."
The "cheating" campaign has stimulated intense discussion among Ugandans on social media and on the streets of Kampala. Critics like Christine Shimanya, an associate vicar at Church of Resurrection, believe the campaign encourages infidelity, while proponents counter that the campaign is realistic. HIV activist Milly Katana stated that "multiple, concurrent partnerships" are a major cause of HIV incidence in Uganda. Both sides agree that old HIV prevention messages are stale, and fresh messages are necessary to motivate Ugandans and prevent new HIV infections.
The full report, "Couples-Focused Behavioral Interventions for Prevention of HIV: Systematic Review of the State of the Evidence," was published online in the journal AIDS and Behavior (2010; doi: 10.1007/s10461-008-9471-4).