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Abstract
This article investigates the historical origins of Uganda's HIV and AIDS prevention and the challenges it faced. By utilising a variety of sources, the article draws a picture of the early prevention campaign that ended in crisis in 1990, the consequent refurbishment of anti-AIDS efforts in the early 1990s and the ideological and practical problems they faced. The article argues that before the mid-1990s the HIV prevention measures were reluctantly accepted by the majority of Ugandans and that not only the Ugandan public, but also the political leaders, donors and professionals involved in AIDS control in the early 1990s recognised this. The article puts the making of the Ugandan ‘success story’ in its historical context, suggesting that it may have involved motives of great urgency and significance for the future of anti-AIDS work in sub-Saharan Africa.
Acknowledgement
The author wishes to thank Herbert Tumusiimwe, Jonathan Ngobi and Thomas Kanooti.
Disclosure statement
No potential conflict of interest was reported by the author.
Notes
1. Seeley, HIV and East Africa; Doyle, Before HIV; Kinsman, AIDS Policy; Thornton, Unimagined Community; Iliffe, The African AIDS Epidemic; Kuhanen, “Deadly Gonorrhea.”
2. See Kuhanen, “Historiography.”
3. Hogle, What Happened in Uganda?
4. Kinsman, AIDS Policy, 71–72.
5. Ministry of Health, “Release of Key Results”; The Daily Monitor, 3 March 2012; The Daily Monitor, 19 March 2012.
6. Museveni, “Report.”
7. Green et al., “HIV Prevention Success”; Kirby, “Changes in Sexual Behaviour.”
8. USAID, “The ABC's”; Timberg and Halperin, Tinderbox. For critical analysis, see Parkhurst, “Ugandan Success Story,” 78–80; Parkhurst, “What Worked?,” 275–283; Thornton, Unimagined Community, chapter 2; Chin, AIDS Pandemic, 153–154.
9. Ghys et al., “Correspondence,” 1425; Dyer, The Story of AIDS, 26.
10. See Kuhanen, “Balinsalamu,” 38 (endnote 17); Kinsman, AIDS Policy, chapter 6.
11. See Henige, “Oral Tradition.”
12. Recommendations for a plan for action for AIDS control in the African region of the WHO, 6 February 1986, WHO/SPM/WP/05 Add. 1; Workshop on AIDS in Central Africa, Bangui, 22–25 October 1985, WHO/CDS/AIDS/85.1; Special Programme on AIDS: Strategies and Structure. Projected Needs, WHO/SPA/GEN/87.1; AIDS Prevention and Control in the African Region, 20 August 1990, WHO/AFR/RC40/3 Add. 1.
13. Interview with medical doctor, 3 December 2007, Kampala.
14. Olowo-Freers, Sociocultural Aspects, 13–18.
15. The AIDS Epidemic, The Message of the Catholic, 3–5, 11; Batwala, “Speech,” 19.
16. Kinsman et al., “Implementation”; Ankrah and Rwabukwali, Knowledge, Attitudes and Practices, 25–25, 57–58.
17. UNICEF/SYFA, New Phase, 15, 19.
18. Munno, 14 January 1988.
19. The AIDS Epidemic, The Message of the Catholic; Museveni, What Is Africa’s Problem?, 247–256.
20. See Guidelines for Resistance Committees on the Control of AIDS. s.l.: UNICEF; NRM Secretariat; Uganda Ministry of Health, s.d., 2–3, 40–48; Parkhurst, “The Response,” 571–590.
21. Waal, AIDS and Power, 94–111; Lyons, “The Point of View.”
22. Seidel, “Thank God I Said No to AIDS”; Lyons, “The Point of View,” 141–145; Feldman, “Conclusion,” 283.
23. Harmsworth, “The Ugandan Family,” 91–100; Hooper, Slim, 288; Weekly Topic, 7 March 1980.
24. Munno, 20 July 1987; The New Vision, 25 April 1988.
25. Okware, “Towards,” 726–729; Ministry of Health/AIDS Control Programme (MOH/ACP), Progress on the AIDS Epidemic in Uganda 1987–89, 6.
26. Carswell, “AIDS in Uganda,” 24–25.
27. The New Vision, 9 September, 3 October, 28 October 1986.
28. The New Vision, 12 July 1988; Interview with medical doctor, 23 May 2008, Kampala.
29. Lema to Bata, 14 November 1988/WHO/GPA/A20-370-2 UGA/4; Ankrah to Carballo, 4 November 1988/WHO/GPA/A20-370-8 UGA; Memorandum by Widdus to Friel, 10 January 1989/WHO/GPA/A20-370-2 UGA/4; Feeney to Mann, 21 December 1989/WHO/GPA/ A20-370-2 UGA/6.
30. Owor, “Education”; The Star, 18–19 July 1989; The New Vision, 11 August 1989; Moodie et al., An Evaluation Study, 17.
31. The Star, 28 April 1986; The New Vision, 28 May, 24 June 1986; Weekly Topic, 9 September 1987; The Star, 28 April 1989.
32. Munno, 1 December 1989.
33. The Star, 19 July 1989; Weekly Topic, 6 December 1989; Weekly Topic, 27 July 1990.
34. Ankrah et al., “The Family”; Ankrah et al., “AIDS and the Church”; Ankrah and Ouma, “Impact of AIDS”; Konde-Lule et al., “Knowledge,” 513–518; Ankrah and Ouma, AIDS in Uganda.
35. Interview with epidemiologist, 16 October 2007, Kampala. See also Grant et al., “Trends of HIV”; Plummer et al., “A Bit More Truthful.”
36. Hudson et al., “Risk Factors”; Forster and Furley, “1988 Public Awareness”; Assessment of the Impact of Group Health Education Regarding the Control of HIV Infection and AIDS in a Rural Area of Uganda. WHO/GPA/667/A20-442-2 UGA.
37 Barnett and Blaikie, AIDS in Africa, 45; Bukenya, Pastoral Care, 33–48; Kuhanen, “Balinsalamu,” 35–36.
38 The New Vision, 9 January, 7 August 1987; 31 March 1988; 3 May 1989; 25 October, 29 November 1991.
39 The New Vision, 15 June, 22 June 1990.
40 See MOH/ACP, AIDS Surveillance Report, Third Quarter, Citation1990, 1.
41 Olowo-Freers, Sociocultural Aspects, 16; Interview with health educator, 8 November 2007, Kalisizo; Group interview with men, 15 May 2008, Kangabwe; Group interview with men, 6 May 2008, Kampala-Mulago.
42 Interview with medical doctor, 3 December 2007, Kampala; The New Vision, 15 June 1990; Munno, 24 August 1988.
43 The New Vision, 26 January 1987; 25 April 1988.
44 Interview with epidemiologist, 16 October 2007, Kampala; The People, 20 November 1996; The Monitor, 27 February 1997; The Sunday Vision, 28 September 1997.
45 See Westway et al, “Feckless”; Nyanzi et al., “Male Promiscuity.”
46 Munno, 24 August 1988; 11 December 1989; Okware, “Towards,” 726–729; Okware, “Giving,” 18–20.
47 The New Vision, 31 August 1990; Weekly Topic, 1 November 1989; 27 July, 14 December 1990.
48 The New Vision, 15 June, 19 June, 25 July 1990; MOH/ACP, AIDS Surveillance Report, Third Quarter, Citation1990, 15; Notes on the meeting between Dr Muzira, DMS Uganda and R. Widy-Wirsky, J. Wickett, and B. Daly, 15 May 1990, WHO/GPA/A20-370-2 UGA/5.
49 Feeney to Mann, 21 December 1989; MOH/ACP, AIDS Surveillance Report, Third Quarter, Citation1990, 15; MOH/ACP, AIDS Surveillance Report, Fourth Quarter, Citation1990, 23; Aide Memoire by Joint Government of Uganda and Donor Mission on HIV/AIDS, 6 September 1990, WHO/GPA/A20-370-2 UGA/8; The New Vision, 7 September 1990; Prevention of Sexual Transmission of Human Immunodeficiency Virus. WHO AIDS Series 6 (Geneva: WHO, 1990).
50 Current and Future Dimensions of the HIV/AIDS Pandemic. A Capsule Summary, September 1990, WHO/GPA/SFI/90.2 Rev 1, 7–8.
51 Culotta, “Forecasting,” 852–854; Financial Times, 21 February 1991; The New York Times, 30 January 1991; USAID, USAID Action Plan, 22.
52 Weekly Topic, 7 December 1990; The New Vision, 2 March 1990.
53 The Star, 5 December 1990: Munno, 3 December 1990; Weekly Topic, 14 December 1990; The New Vision, 20 April 1991.
54 The New Vision, 10 January, 18 June, 21 November, 11 December 1991; The New Vision, 7 December 1992.
55 W. Namaara and S. Okware to D. Tarantola, 7 March 1990, WHO/GPA/A20-370-2 UGA/5; The HIV/AIDS Pandemic: 1994 Overview, 9–10, WHO/GPA/TCO/SEF/94.4; Armstrong, Uganda’s AIDS Crisis, 12–13; Uganda AIDS Commission, “Multi-sectoral.”
56 Proposed Programme Budget for 1994–1995, WHO/GPA/DIR/93.1, 10–15, 49; Report of the Tenth Meeting of the Management Committee, WHO/GPA/GMC(10)/94.14, 35; Editorial, “Fortress WHO,” 203–204; Patterson, The Politics of AIDS, 3; Parkhurst, “Ugandan Success Story?,” 80.
57 The Costs of HIV/AIDS Prevention Strategies in Developing Countries, WHO/GPA/DIR93.2, 8; Feeney to Mann, 21 December 1989.
58 See Kirby, “Changes in Sexual Behavior,” ii38–ii39.
59 “AIDS in Uganda: Social and Behavioral Dimensions of the Epidemic. Report of the Pretest, April 1989,” WHO/GPA/A20-370-8 UGA.
60 The Weekly Topic, 18 January, 14 June 1991; The Monitor, 21 February 1997; Kaleeba, Open Secret, 12.
61 Uganda Health Bulletin, 1 (1992), 8–11; The New Vision, 1 December 1995; The Monitor, 29 September, 2 October 1995; The Monitor, 1 December 1995; The New Vision, 2 December 1997.
62 The New Vision, 24 February, 16 June 1992; The New Vision, 26 May 1993.
63 Ankrah and Ouma, “Impact of AIDS”; Musagara et al., “Recent Changes”; Grant et al., “Trends of HIV”; The New Vision, 9 July 1994.
64 Moodie et al., An Evaluation Study.
65 Moodie et al., An Evaluation Study., 52; Also Group interview with women, 13 May 2008, Kateera; Group interview with women, 6 May 2008, Kampala-Mulago.
66 Olowo-Freers, Sociocultural Aspects; Nabaitu et al., “Community Perceptions”; Bakibinga and Kasozi, “Overcoming”; The Monitor, 11 December 1992; Weekly Topic, 14 May 1993.
67 Ssali et al., “Exploring”; Kaharuza et al., “Risk Perception.”
68 The New Vision, 1 February, 8 February 1994.
69 The New Vision, 18 June 1993.
70 The New Vision, 4 September, 10 October 1993; The Monitor, 3 December 1993; The New Vision.
71 The New Vision, 2 December 1993.
72 The New Vision, 22 April 1992.
73 The New Vision, 22 April 1992.
74 MOH/STD/AIDS Control Programme, Surveillance Report, June 1993, 1; The New Vision, 24 February 1992; The New Vision, 14 March 1993.
75 The New Vision, 14 March, 23 May 1993; The New Vision, 29 July 1994.
76 The New Vision, 20 February, 24 February 1995.
77 Konde-Lule, “Declining,” 28.
78 The New Vision, 9 July 1994.
79 The New Vision, 24 February 1995.
80 Opio et al., “Sexual Behavior.”
81 Kengeya-Kayondo et al., “HIV-1 Incidence”; Mulder et al., “Decreasing”; Wawer et al., “Incidence”; Wawer et al., “Trends.”
82 Boahene, “International Conference.”
83 Workshop on the Status and Trends of the HIV/AIDS Epidemics in Africa: Final Report, available online at: http://fhi.org/en/HIVAIDS/pub/Archive/confrpts/Wkshp_Status_Trends_HIV_AIDS_Africa.htm (accessed June 14, 2012); The Status and Trends of the Global HIV/AIDS Pandemic: Final Report, available online at:http://www.fhi360.org/en/HIVAIDS/pub/Archive/confrpts/Status_Trends_HIV-AIDS_Pand_Fnl_Rprt.htm (accessed June 14, 2012); Timberg and Halperin, Tinderbox, 132–135; Chin, AIDS Pandemic, 153–154.
84 The New Vision, 29 May 1996.
85 The New Vision, 15 December 1995; The New York Times, 7 April 1996.
86 The New Vision, 11–14 December 1995.
87 See Mulder et al., “Decreasing.”
88 Boahene, “International Conference,” 613.
89 See Aral, “Behavioral Aspects,” 327–328.
90 The Status and Trends.
91 Piot, No Time to Lose.