Uganda has been the Wonder Child in the whole fight against the scourge of AIDS. But just like any Hollywood Kid Wonder, as of late it might just have been involved with the “wrong crowd”. While others are influencing it against its focused narrow path, we are watching the numbers of infected & dying Ugandans turn uphill and steadily climb.
People are flying into a right panic about why. Does this mean that the strategy that we have been copying for a good decade and more not actually work? Does such a strategy expire from AIDS fatigue? Is it the political situation of warfare giving people other worries? Is it elements outside what we have so far attributed to the Ugandan success?
A fascinating article appeared in the Washington Post about the Uganda AIDS situation & its history. The journo puts forward the theory that the reason for the about-turn in an excellent achievement is the forgotten spotlight on “Fidelity”.
Uganda is championed as initiating the programme that was to become known as the A.B.C. of AIDS Prevention. Abstain. Be Faithful. Consistently & Correctly Condomise.
After watching an early success, organisations, governments and donors have taken this on and attempted to make it into a universal package. But gradually people found their corners of the fight ring. The right-wing and religious guys push for Abstinence (in sometimes disgraceful ways!), while the liberals are saying, “Let the people shag, but give them & teach them about condoms”.
“Being Faithful” has been left by the wayside. [Note: the “B” also means a fewer sex partners in one’s lifetime. Be cautious, Be faithful, Be scarce.]
In the 1980s Uganda started with pushing local messages of “Zero Grazing Areas”: an agricultural term inspired by the zero-shaped patch created when livestock were tied to a post and allowed to eat only from a single section of grass.
Over the decades, and as the Global AIDS “Team” realised Uganda was doing something right - “The initiative had been overtaken by big-budget, bureaucratic programs that resembled those in most African countries. Persuading Ugandans to stay faithful to their partners was no longer the focus... "It was a mistake," Okware said. "That message was loud and clear."… Nearly 18 years after [the] dramatic crusade, billboards warning against the dangers of reckless sex are hard to find in today's Kampala, the graceful, hilly capital. Far more common are photocopied fliers brazenly saying "Get a Lover" and listing a cellphone number”.
Ugandans are now like the rest of us, and are not afraid of HIV, and so are acting accordingly.
For some reason, perhaps the “faithful” theme reminded me of another fascinating more-left-field “faithful” theory I read in 2004. On why the spread of AIDS is in the global pattern it is. (It would be almost impossible for me to find that article now.)
The author proposed that people had multiple sex partners the world round, but it was the nature of these relationships in each area that affected the AIDS infection demographics.
People in Africa will have several sex concurrent sex partners. They would be sleeping with the same people for years and years. It just so happened that the timing of these relationships overlapped. Think of a spider wed of sex (Or of the FaceBook of Sex!)
People in Asia are unfaithful to their partners, but rather in once off situations. They will visit prostitutes often, but generally never the same prostitute twice.
People of the West have multiple sex partners but never at the same time. Rather each relationship will follow on the tails of another, but not run at the same time. (From my experience of some Western men, I might have to laugh my head off at this point).
As HIV, [and I say this with the trust that you are not going to misuse such a piece of information in immature ways – do not play around with death & think you have any clue what your risk is in a situation], does not NECESSARILY transmit during a once-off encounter. [But it CAN! Just like pregnancy can just happen with a one-nighter].
This means that a once-off with a HIV-positive prostitute lessens the Asian person’s chance of infection. The Western person is theoretically practicing “Be Faithful”. And the African person is, well, screwed.
So perhaps this continent does call for people to have fewer casual sex partners & to remain faithful to each one, who they are with in isolation. “They” being you and me, by the way. It always seems the author & reader forget this point.
The Washington Post article ends with:
Raymond Kwesiga had a girlfriend, several occasional partners and a knack for seducing others so reliable that his friends dubbed him "Raymond the Great," he said. Many nights, too lazy to call a girlfriend after downing a bottle of Uganda's bitter national liquor, Waragi, he spent 75 cents to hire a prostitute.
Sometimes he used condoms, sometimes not -- a common but uneven approach that research shows almost entirely undermines their value.
"I was enjoying my life, and I thought I wouldn't get the virus," Kwesiga said, speaking with the deliberate cadence of one trying to live up to newly learned ideals. "I wasn't very scared. . . . During the night, you don't get scared."
He is now HIV positive.
Now many of Kwesiga's nights are filled with fear. He fears dying. He fears he may not be able to marry or have children. And with the painful clarity that has come with sobriety, he fears he may have given HIV to somebody else.
[To add to a point made earlier – the more violent the sex, the higher the chance of HIV being transmitted, as there will be more cuts, tears (if even micro), blood and bodily fluids involved. This means that if you have been assaulted, if only once, do not take the chance, go straight to a clinic for PEP.]