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S. Mulongo: Reducing AIDS Through Moral Education
Written by Simon Mulongo, Presidential Resident District Commissioner, Uganda
Friday, July 23, 2004
Presented to Assembly 2004, “Establishing a World Culture of Heart: Innovative Approaches to Peace in a Changing World,” Seoul, Korea, July 23-27, 2004
I will cover Uganda’s experience in combating HIV/AIDS. In Uganda, AIDS is real. It is a common subject; it is a household word, talking about AIDS and HIV. AIDS has affected everybody in Uganda in one way or another. I personally lost my eldest brother, who left behind six kids and are a big burden to us. Our former president, His Excellency Godfrey Binaisa, will tell you the same story. He is fathering, not as a father himself, but grandfathering some number of children, because of the problem of AIDS. We cannot tell when AIDS started in Uganda, but probably the first case was discovered in 1982 in the southwestern district of Rakai. By 1990 the problem had become pandemic, of national proportions, with the possibility of wiping out the population, starting with the most productive.
Just to give you a glimpse of some figures, by 1984 Uganda had a population of 18 million people and 1.5 million of them were infected. The rate was growing at between 26-31 percent per year. As I will relate, we managed to fight this scourge and we’re now talking about the infection having dropped to between 4 and 6 percent in various places in the country. It is not true to say that Uganda is a success story, because the disease is still there. We are supposed to eradicate the disease, not reduce the rate of incidence. Therefore, when you copy us, do much better than Uganda because Uganda’s case is not necessarily the most successful.
In Uganda the transmission of AIDS is through unprotected or undisciplined sexual behavior, blood transfusion of infected products, sharing syringes among drug users, and sharing unsterilized knives in male or female circumcision, which is common in some parts of Uganda. The most tragic cause to mother-child transmission.
Today, the population most affected are adults between the ages of 18 and 45, but this does not mean that those below 18 are not affected. People as young as 9 and as old as 80 become infected.
AIDS is perceived as a medical problem, but AIDS is not mainly a medical problem; it is a moral problem. It is a social-economic problem as well. It is not medical, because it is not just very infectious. You cannot get AIDS through drinking from the same cup of coffee with somebody else or sharing a straw of beer. We have in Uganda a local brew called Malwa, and people share the straws; you cannot catch AIDS because of sharing a straws or traveling in the same vehicle with somebody infected with AIDS. Surprisingly, you cannot catch it even through a mosquito bite. There are also cases of married couples where one is infected and the other is not. One may be infected for many years and pass away, and the other's test results always turn up negative. So it is difficult to explain.
As a moral problem, the infects are related to immorality, particularly promiscuity or sex outside marriage. We have many cases recorded of premarital sex; we have many cases recorded of unfaithfulness of partners. There are also cases of polygamy or monogamy that encourage surreptitious side relations, or secret acquired relations. Of course the whole thing boils down to unfaithfulness—premarital sex and unfaithfulness. These are key and very common in Uganda.
Our government has a lot of initiatives to combat AIDS. The first thing being an admission of the problem, an admission that there is an epidemic, and therefore the necessary anxiety to fight it. Many governments do not want to admit because that might affect the number of people coming into the country, such as tourists. Tourists are not going to a country where they think they may be endangered. Many tourists go sightseeing and enjoy the social life. If there is an AIDS epidemic, they stay away. Many countries in the neighborhood of Uganda would not speak loudly or speak openly about the problem of AIDS.
Uganda admitted there was a problem. Indeed, President Museveni spoke publicly about this epidemic. The government thereafter drew up an integrated, comprehensive, holistic, and systemic course of action that has been championed by the President, the First Lady, and all organs of government. It also includes NGOs and faith-based organizations. This approach drew a high-level political response and involved centralized structures and then passed responsibilities from the top to the grassroots.
Initially it was very difficult to talk about things like condoms, because people were shy. How does a father tell a son how to use a condom? Just imagine that you are now sitting with your son and telling him or advising him to use a condom. It was very difficult. But today in Uganda we talk openly about AIDS, we talk about anything to do with sexuality, we talk about sex education in schools, talk about all those details. We’re counseling, testing, and creating positive-test clubs and associations. After testing, they form associations based on whether they are positive or negative, and people discuss frankly and openly about the problems they encounter. They, thereby, comfort each other and help each other find the way forward. So testing and finding oneself positive in Uganda is not the end of the road but just the beginning of so many things to be done to sustain life. This includes the introduction of retroviral drugs that have been used extensively with very good response.
Comparatively, Uganda is rated very successful. Some of the reasons include the following:
1. We emphasize behavioral change, because most infections are through heterosexual sex. We have designed programs and projects to ensure that the behaviors of people change. This is the most difficult part of it, because behavior is difficult to deal with. Some people say you can’t teach old dogs new tricks. So how do you teach adults who are old enough new tricks? It is a very difficult and complicated subject. We have introduced studies in schools and universities promoting behavioral change to prevent AIDS.
We also designed, together with other nations, the ABC model: A is Abstinence, B is Be faithful, C is Condom use, with condom used correctly and consistently. My president was widely quoted as condemning condoms. But he never condemned condoms. Rather, he emphasized that A and B, abstinence and being faithful as more fundamental, and condoms as a last resort for those who cannot change their behavior.
Uganda designed simple but effective messages appealing to people of all ages urging them to avoid AIDS through controlled sexual behavior. These are preached throughout the population profile. Children in nursery schools are told about the threat of AIDS, even to the most aged. We have tried to use influential political leadership across the country, vertically and horizontally. Political leaders an be change agents, so you have to use them. First, get them on board. Let them understand and appreciate the problem. Help them realize the magnitude of the problem, and use them as vehicles to change others. Also we campaign to instill moral values, because when problems arise people tend to look toward God. When a ship is about to capsize, even one who has never said a prayer will shout one. Uganda turned to God, and so many religious organizations are doing a great work.
The Uganda chapter of IIFWP is one of the leaders in a campaign based on the family unit. If you can salvage the family unit and put it on track, then the village will recover, the district will be on course to lead the entire country, and the country will recover. This is quite a slow and painful process, but it is the surest way. We have also tried to emphasize positive cultural traits, such as virginity before marriage, because traditionally after a wedding the bride's paternal aunt must testify that there was blood at the first encounter between the bride and groom. Because of interference from foreign cultures, we were losing the emphasis on virginity. But we are trying to recover it.
We also emphasize "zero-grazing" among married couples. Zero-grazing means you stay faithful to your partner. If you are a man with three wives, then you should be faithful to those wives and they should be faithful to you. There should be no going beyond that. If you are in a one-to-one relationship, you should stay there. We discourage multiple sexual partnerships. This is quite a big achievement to reduce multiple sexual partnerships, because when we trace the trail of an infection, one man infects 10 to 20 women. This education was formerly under the Minister of Health, but now it is the responsibility of the office of the president, to ensure that the president himself is aware.
In conclusion, the Ugandan experience has seen a reduction in the infection rate from about 31 percent to 5 percent. This has been a hard-earned accomplishment. The government spends about $35 million a year on HIV/AIDS prevention, and we are thankful for the global fight against AIDS and other diseases such as tuberculosis and malaria. The Bush administration has pledged and delivered some money, but the challenge continues. This past year the rate of infection stabilized, meaning that it is not dropping, and this worries us a great deal. That means that people are getting used to the methods we use and the messages we have been sending, so we must change our tactics. The marketing mix must change, and we must step up human and financial resources to insure that we combat and eradicate AIDS, not just from Uganda but from the entire globe.