  In recognition of their commitment in the fight against AIDS in their
countries, Presidents Yoweri Museveni of Uganda (left) and Abdou Diouf of
Senegal received excellence awards at the seventh conference of the Society
for Women and AIDS in Africa (SWAA), held in Dakar last December. Sustained
preventive information campaigns and services have brought HIV infection
rates down from double to single-digit levels in Uganda and kept infection
rates extremely low in Senegal. |
High-level political commitment, coupled with prompt action in Uganda and Senegal, has shown that the AIDS epidemic can be contained and even reversed. Uganda has cut HIV/AIDS prevalence from double-digit figures to around 9 per cent (and in some age groups by half), while Senegal has stopped infection rates at between 1 and 2 per cent.
These two countries, with their differing HIV/AIDS incidence and prevalence, could serve as inspiring models for African countries where infection is still rising. Uganda has shown that the epidemic can be reversed, while Senegal has demonstrated that it can be stopped from taking a hold. Both countries have shown that Africans have the power to control and conquer the epidemic through public information campaigns -- provided there is enough political will and investment of resources.
Uganda, perhaps the most notable example, was quick to accept the grave reality of the disease -- which is mainly transmitted in Africa through heterosexual sex -- and generated the will to fight it. When AIDS was first diagnosed in the country, the government promptly mounted a campaign to raise awareness and informed Ugandans with unusual frankness about how the disease is spread. Billboard warnings were prepared and set up everywhere. Messages on radio were constant. "Just assume that everyone is infected," warned one message that was repeatedly aired.
The disease was first detected in Uganda among the people living along
the shores of Lake Victoria in the mid-1970s and came to be known as the
wasting "slim disease." The first formal diagnosis was made in
1984. President Yoweri Museveni acknowledged the problem soon after coming
to power in 1986 and although the country's infrastructure and health services
were ravaged after 15 years of brutal civil war, his government set up a
national committee for AIDS prevention that same year. He took a leadership
role that has had a tremendous impact on the anti-AIDS campaign. 
Photo: UNICEF / Jorgen Schytte
In 1991, the campaign grew into an intensive multi-sectoral and multi-media saturation effort. Condoms were distributed and voluntary HIV testing carried out. Counseling and support services were provided, while pop songs, billboard and radio messages popularizing anti-AIDS messages were created. Drama performances and open-air seminars on sex education were held routinely.
The country's pioneering efforts in combating AIDS have changed social mores: teenagers are postponing sex, casual sex is declining, and unmarried adults are practicing abstinence. Once unheard of, more and more men and women of all ages are now using condoms. (Some 14 mn condoms were distributed in 1997 in a country of 19 million people.) And in a country where parents once would not discuss sex with their children, sex and HIV/AIDS are discussed almost routinely all over Uganda.
As a result, HIV/AIDS prevalence, which had soared until 1993, has been dropping for the last five years. HIV prevalence among women in urban antenatal clinics, for example, fell by half, from roughly 30 per cent in 1991 to 15 per cent in 1996. The estimated HIV infection rate at the end of 1997 was 9.5 per cent of adults aged 15-49. The decline in infection rates has been faster in the urban areas, where the public information campaign is concentrated, than in rural areas where infection rates have been relatively lower. Recent surveys indicate the following achievements:
When AIDS was detected in Senegal, the government also promptly organized an education and awareness campaign. Although with a population of only 9 million and far lower rates of HIV/AIDS prevalence than Uganda, mass media messages were similarly created, discouraging high-risk sexual behaviour and promoting the use of condoms. Media interventions, targeted information campaigns, and research activities were designed to help slow the spread of the HIV and other sexually transmitted diseases (STDs).
With donor and non-governmental organization support, Senegal established effective HIV/AIDS/STD services. A pilot project on social marketing of condoms exceeded its expected level of sales by 42 per cent in the first 10 months and condom sales soared from 800,000 in 1988 to 7 mn in 1997. Condoms are now available in 252 pharmacies and 80 pharmacy depots throughout the country. Senegal has also involved its religious leaders in the fight against AIDS. For example, it organized two national conferences on HIV/AIDS prevention in late 1995 and 1996 in which Islamic and Christian leaders became better informed about HIV/AIDS and identified their roles and responsibilities in preventive efforts. This was a first in Africa. In Kenya, for example, some religious leaders fight against the use of condoms and sex education.
Senegal's strategic interventions to reach targeted groups with critical preventive information and services have ensured that national rates of HIV/AIDS prevalence have remained low -- at around 1.7 per cent (1998 figures).
The bold, innovative and pioneering efforts of both Uganda and Senegal in combating AIDS have received international recognition. In December 1998, the seventh conference of the Society for Woman and AIDS in Africa (SWAA), held in Dakar, presented both President Yoweri Museveni of Uganda and President Abdou Diouf of Senegal with excellence awards in recognition of their commitment in the fight against AIDS.
The example provided by Uganda in particular has attracted the attention of other countries and researchers. During an experts' panel discussion at the SWAA meeting, Ms. Noerine Kaleeba of the Joint UN Programme on HIV/AIDS (UNAIDS) said that African countries need to copy Uganda's anti-AIDS strategy. And World Bank HIV/AIDS Coordinator Debrework Zewdie recently told Africa Recovery that the Bank is trying to determine why infection rates have been going down in Uganda. "The findings will be useful not only for the Bank's projects in Uganda but in other countries as well," she said.
For Dr. Peter Piot, executive director of UNAIDS, the solution to the HIV/AIDS epidemic is in Africa itself already. The problem, he says, is that "we are not doing enough." Citing Uganda and Senegal as inspiring examples, Dr. Piot urges African states to take HIV/AIDS more seriously and invest more resources in prevention campaigns. These should include the promotion of abstinence, faithfulness to single partners, the widespread distribution of condoms and sex education to teach young people how to avoid the virus.
Dr. Piot says infection is still rising in sub-Saharan Africa because what is being done for prevention is "fragmented" and "not enough." The situation could get worse if efforts are not made -- from the highest level of government to the grassroots population -- to recognize the disease as "a major impediment to development," he says. "There is need to make HIV discussable at all levels involving community and religious leaders. Currently the disease is still too hidden.''
Governments "don't have to wait for many people to die of AIDS before acting decisively," Dr. Piot adds, pointing to the vigorous preventive campaign Senegal waged before the epidemic struck. This effort resulted in the country's low HIV prevalence rate of between 1 per cent and 2 per cent.
African states should introduce sex education programmes in schools, intensify the distribution of condoms and remove barriers that prevent HIV-positive people from going public, Dr. Piot concludes.
He says although Africa now has the largest number of HIV cases worldwide,
the continent has the ingenuity and resources to overcome the pandemic.
"Africa will survive this tragedy just as it was able to emerge from
other natural and man-made disasters, including colonialism and slavery,''
he told the Pan African News Agency in a recent interview. But he warned
against expectations of quick results. "This is an affair of changing
people's behaviour. It took Uganda 10 years to start seeing changes,'' he
pointed out.
