C is quite crucial in the ABC gospel

Sep 04, 2005

HE was very blunt and undiplomatic. US policy, he said, was frustrating HIV prevention in Africa. It was responsible for Uganda’s current condom shortage. <br>That was Stephen Lewis, the UN Secretary General’s Special Envoy on HIV in Africa.

Paul Ssemugoma

HE was very blunt and undiplomatic. US policy, he said, was frustrating HIV prevention in Africa. It was responsible for Uganda’s current condom shortage.
That was Stephen Lewis, the UN Secretary General’s Special Envoy on HIV in Africa.

He was justified. The frustrations he voiced have been simmering amongst professionals for a long time. Uganda gave the world the HIV alphabet, ABC. And yet it is in Uganda that the C is being dropped, leaving AB.

Background

Uganda stands out in HIV prevention. Back in the 90s when it was a terrible disease, we talked about Abstaining, Being faithful, and using Condoms (ABC) while many other countries in Africa and the world were mincing words. The result was dramatic.

Slowly but surely, the epidemic was turned around. We are a third world country. Showing the world that straight talking could beat HIV was a phenomenal achievement. It was a result of great leadership and an appreciation of the fact that we have a monster (HIV) loose in our midst. With people dying left, right and centre, we could not and did not ignore the virus.

ABC is not perfect. It ignores homosexuals, a key population. Not everyone can follow it. Traditionally, the woman has little say in matters of sex, especially concerning her husband. Yet, imperfect as ABC is, we showed it could work. But now we are turning back.

Why?

Most of our funding to fight HIV came from America. In 2002 there was a ‘regime change.’ Out went liberal, pragmatic Clinton, in came G.W Bush, with strong views on moral issues including a bias against the condom.

He started the (US) ‘Presidential Emergency Plan for AIDS Relief’ (PEPFAR), but the HIV war had taken on a ‘moral’ tone. Abstinence and Being faithful (AB) programmes were strongly favoured. Beneficiaries of PEPFAR had to condemn prostitution. The reasoning is moral, not scientific. Brazil is refusing the money rather than alienate key populations and Senegal was cut off. Uganda took the money.

What’s wrong?

Superficially there is nothing wrong with Abstinence and Being faithful (AB). Sex is the major means of HIV transmission.

Logically if you do not have sex, you are safe. If you have sex in a mutually monogamous relationship, with both partners negative, you will be safe. It sounds good, moral, and perfect.

There is (very) strong political backing. With church support, and funding from PEPFAR, the AB crowd in Uganda grew powerful. Billboards all over Kampala attest to it. But to the AB crowd, condom is a dirty word. They are fiercely against condoms. They openly de-campaign condoms, saying AB is the only thing.

Fact and Fiction
We are human beings. If one abstains today, tomorrow that can change. The one who abstains must still know how to use the condom correctly. Being faithful can be fiction in the real world. Men and women cheat on their mates, and you can only hope that your mate is using a condom when he or she is unfaithful!

Fiction is being propagated that condoms confuse school children, who must be taught abstinence only. In reality, most of us adults had our first sexual experiences in school. Many school children are sexually active, whether we accept it or not.

AB ensures that they do not know about condoms, even when they decide to have sex. It means that the only chance that they will have to know real protective behaviour is after S6, when they are over 20 years of age!

We cannot relax. Uganda has too much HIV. People who have sex need the condom. Everybody needs to know how to use condoms correctly. Fighting the condom is national suicide.

Advice
Condoms work. If you are HIV negative with an HIV positive partner transmission of the virus occurs about 30 times for 10,000 times you have sex without condoms. It is the reason why there are couples with one positive, and the other is negative. Condoms, when correctly used, decrease the transmission of HIV.

When the bedroom doors are closed, and abstinence is left on the cold, lonely church pews, remember basic protective measures.

Sex is sweet. (if it is not for you, see your doctor). If you have decided to be faithful (pray that your partner is) remember to use condoms, when you are unfaithful. And use condoms, always, when you have any doubts. Add D to the HIV alphabet; Don't be Deceived!

The writer is medical doctor

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