Ottawa Citizen examines campaign aimed at changing behavior in Uganda to fight HIV/AIDS

The Ottawa Citizen on Sunday examined a campaign in Uganda aimed at stopping unsafe sexual behavior -- particularly among young women and older men -- that is contributing the spread of HIV in the country.

Uganda "stands out as one of the world's success stories in battling and preventing" HIV/AIDS, the Citizen reports. The country's HIV/AIDS prevalence about 20 years ago was 15% among the general population and up to 30% among pregnant women in some areas. Although the country reduced its HIV/AIDS prevalence through a variety of prevention efforts, there has been a resurgence of HIV in the country that has led some researchers to ask aid agencies to rethink the prevention strategies of promoting condoms, abstinence, drug treatment and HIV testing they currently are funding.

Julius Lukwago, a spokesperson for Population Services International Uganda, said the campaign aims to promote fidelity by eliminating the socially acceptable practice of cross-generational sex, which is defined as a nonmarital relationship between a young woman and a man who is at least 10 years older. It also is intent on shaming the men who engage in such relationships, outraging the community and building the self-esteem of young women. According to the Citizen, churches also are involved in speaking against the practice, and national figures such as first lady Janet Museveni have voiced their support for such efforts.

The campaign began as a pilot project in 2006 as HIV incidence, which traditionally has been higher among young women, began to increase. Studies suggested that HIV incidence increases among young women when their male partners are more than 10 years older, the Citizen reports. A PSI Uganda survey also found that more than 16% of young women at universities have had multiple sex partners in the past 12 months, many in concurrent relationships with older men and boyfriends. The study also found that 36% of young women think such relationships are normal. Twebese Rukandema of PSI Uganda said these relationships are built on age, economic and power "asymmetries between partners." According to the Citizen, the campaign borrows from President Yoweri Museveni's "zero-grazing" campaign that promoted fidelity 20 years ago.

The article also examines concerns among some HIV/AIDS experts that a "new and more complacent generation" in Uganda is participating in the same unsafe sexual behaviors, such as having multiple partners, that contributed to the spread of the disease in the early to mid-1980s. In addition, some experts say that the phenomenon of cross-generational sex is only part of a broader cultural problem of multiple partners. Consequently, Daniel Halperin of Harvard University's School of Public Health said the billboard campaign might only delay HIV transmission, not prevent it. What really is needed is a "low-cost, low-tech" strategy of changing sexual behavior and reducing the number of partners, according to Halperin.

Halperin also questioned whether the current campaign will instill the same personal and visceral fear of contracting HIV among men that Museveni's "zero grazing" campaign did. Halperin said that if the campaign is "successful, you will see HIV in teenagers go down, but if adult behavior doesn't change, they are still going" to contract HIV. He added, "All you're doing with these young women is buying them a few years. By itself, it won't turn the epidemic around" (May, Ottawa Citizen, 8/24).