A, B and C in Uganda: The Roles of Abstinence, Monogamy and Condom Use in HIV Decline

Abstract

Uganda is often cited as a role model in the fight against HIV/AIDS because of its success in reducing both prevalence and incidence of HIV infection since the late 1980s. Although an increase in sexual abstinence has been highlighted as a primary cause of the declines, large increases have also been recorded in monogamy and condom use. The extent to which each of these factors actually influenced the overall decline in Uganda's HIV rates has become a highly charged political issue in the United States, leading to restrictions on how US development funding for combatting HIV is allocated. The Alan Guttmacher Institute investigated changes that occurred in abstinence, monogamy and condom use in Uganda in the 1990s, using nationally representative data from Uganda's Demographic and Health Surveys of 1988 (women only), 1995 and 2000 (women and men), and national-level findings from two surveys by the Global Programme on AIDS in 1989 and 1995 (women and men). Reduction of infection risk by lowering numbers or types of partners among people with more than one relationship was not covered. Here we reprint the chapter on “Implications” from the AGI report, a commentary on the lessons that can and cannot be taken from the data, published in a 2003 Guttmacher Report on Public Policy.

Acknowledgements

The chapter on “Implications” is reprinted with kind permission of The Alan Guttmacher Institute from: Singh S, Darroch JE, Bankole A. A, B and C in Uganda: The Roles of Abstinence, Monogamy and Condom Use in HIV Decline. Occasional Report No. 9, New York: AGI, 2003. The references from this section of the report (numbers 12–17) were re-numbered here.

Notes

* Other research has shown much sharper declines in sexual initiation among primary school pupils aged 13–16 in one district in Uganda (the Soroti District); however, the national data indicate that such large declines did not occur in the country as a whole. It is possible that the greater behavior change in this district resulted from interventions particular to this district; in addition, in general, adolescents attending school may be more exposed to educational interventions than the average adolescent, and more likely to change their behavior in response to such interventions.