AIDS has devastated many Africa countries, and set back development by decades. But Uganda offers hope in the fight against the deadly disease...

AIDS. Africa. Disaster.

That's the link most of us make when we hear the words AIDS and Africa. And no wonder. It's difficult to overestimate how AIDS has ravaged African societies. Of the 40 million people affected by AIDS around the world, three-quarters - over 30 million - live in sub-Saharan Africa. In a single year, 2001, AIDS claimed the lives of an estimated 2.3 million Africans.

The epidemic has dealt a body blow to many African nations, setting back development by decades.

Because of AIDS, average life expectancy has plunged in over a dozen of the continent's countries, and more than 13 million children in Africa are AIDS orphans. .

"Let us not equivocate," warns former South African President Nelson Mandela, "AIDS today in Africa is claiming more lives than the sum total of all wars, famines and floods, and the ravages of such deadly diseases as malaria. It is devastating families and communities."

Uganda is one of the African countries hardest hit. According to a report from the Uganda AIDS Commission, 1.05 million Ugandans of a population of 22.7 million are infected with HIV, and about 120,000 have developed AIDS. More than 800,000 people have already lost their lives.

An estimated two million children have been orphaned by the disease, losing one or both parents.

As in other African nations, the economic and social impacts of the pandemic in Uganda have been devastating. Nearly 80 percent of those infected with HIV are between 15 and 45 years old, the most economically productive people in the country.

The health system has been strained to the breaking point in a country where only half of its citizens have access to adequate health care. Half of the country's hospital beds are taken by AIDS patients. Life expectancy at birth has plunged to 44.

Although Uganda has only 0.4 percent of the world's population, it bears 2.4 percent of the AIDS burden, "six times more than its proportionate share," states the United Nations Development Program.

It sounds like a grim tale, fitting the stereotype of Africa as a "lost continent." Thankfully it's not all bad news.

Uganda is one of the few countries that has succeeded in reversing HIV rates, and the success is nothing less than stunning. An HIV/AIDS rate of 31 percent in the early 1990s - the highest in sub-Saharan Africa - now stands at 6.3 percent. HIV rates have dropped most rapidly in the high-risk 15-24 age group.

How did an impoverished country like Uganda achieve this?

The first step was to simply talk about the disease. That may sound so obvious as to be not worth mentioning, but being honest and open is the key to combating AIDS. Leaders of some other hard-hit African countries, notably South Africa and Zimbabwe, have been reluctant to sound the warning. In contrast, the president of Uganda talks about AIDS constantly.

"When a lion comes into your village, you must raise the alarm loudly," says Ugandan President Yoweri Museveni. "This is what we did in Uganda; we took AIDS seriously and we achieved good results...If we raise awareness sufficiently, it will stop."

Museveni's example has inspired other leading Ugandans to speak out as well. This both helped spread the word and reduce the stigma and isolation experienced by people with HIV in Africa. Previously, many people shunned those who had contracted the deadly virus, refusing to shake hands with them or even talk to them. Some victims were thrown out of their homes.

The second step on Uganda's path to confront AIDS was to involve as many elements of Ugandan society as possible, including churches, schools, community organizations, youth and traditional healers.

In 1990 Museveni's government established the Ugandan National Task Force on AIDS, which a year later kicked off a massive country-wide campaign involving condom distribution and promotion through popular songs, drama groups, counselling and support services. More than 700 groups work with the Uganda AIDS Commission, which coordinates efforts to combat AIDS.

A nation-wide "ABC" campaign was launched in 1995 to promote safe sex among young people: the A stands for abstinence, B for being faithful and C for condoms. Condom use has since risen sharply among youth. Training health workers, creating counselling networks, treating sexually transmitted diseases and expanding HIV testing have also strengthened the country's efforts to combat AIDS.

Museveni has won two international awards in recognition of his fight against the disease, including the Commonwealth Award for Action on HIV/AIDS. His wife Janet Museveni established the Uganda Women's Effort to Save Orphans, an organization that cares for HIV/AIDS orphans

And young people such as Anne Akia Fiedler have helped change people's attitudes and behaviour. She returned to Uganda in 1993 to find her sister wasting away with AIDS. Her sister eventually died. Fielder discovered that more than 30 of her friends had met the same fate. v"People were dying," she recalls. "There was great concern. Something had to be done and there had to be somebody to do it." Fiedler founded the Straight Talk Foundation and started a publication to educate people about AIDS, as well as cover other topics of interest to young people.

The magazine now has a reading population of 1.5 million. And because many rural Ugandans cannot read, Straight Talk recently launched a radio show on health.

The third step was to embrace those most affected - the people living with HIV and AIDS. "We should be involved in the fight against HIV/AIDS," says Rev. Gideon Byamugisha, the first priest in Africa to declare he was HIV-positive. "We are best placed to seek and identify solutions to the problems that affect us and also ways of stopping the spread of the disease."

Byamugisha runs an HIV prevention program for the Protestant Church of Uganda, and was appointed to the board of the Uganda AIDS Commission, the first person living openly with HIV to be affirmed in this way.

There are many others like Rev. Byamugisha who now receive the support they desperately need, and who as a consequence are playing a vital role in encouraging other people to take the HIV test, live positively and support the sick.

Six years ago Rosemary Kityo, 31, discovered she was HIV-positive. Her husband had already succumbed to the disease. Soon Kityo was sick too, and had to look after her remaining three children. Sometimes she survived on just one meal a day. Then a relative introduced her to The AIDS Support Organization (TASO).

"At first I was hesitant," she recalls. "I did not want anybody to know I had AIDS. I thought it was embarrassing. People would despise me." But today she is a member of TASO, which supports people living with HIV/AIDS. Begun by 16 volunteers in 1987, it now has 67,000 members.

"I am happy that I declared my HIV status early," says Kity. "I have received counselling and I think I can be useful to my family and community for a long time."

"Both the Government and NGOs have done a lot of work, but you can't discount the role of community-based organizations and people living with HIV/AIDS," stresses Joyce Kadowe, a social scientist at the Uganda AIDS Commission.

Finally, the fourth step was to acknowledge the place women have in fighting AIDS, and to ensure they have a central role in combating the disease. Women are most affected by poverty in Africa and have been hard hit by AIDS. The face of AIDS is an increasingly female one, with women now making up the majority of victims. In Uganda's male-dominated society, it can be difficult for women to say "no" to unsafe sex that leads to HIV.

Women also do nearly all of the nursing and care-taking work involved in families.

"We are the real experts in our communities about how HIV infection affects individuals and their families," a group of 130 Ugandan women declared at an international conference on strategies for preventing HIV. "We should be trained as lay counsellors, trainers and program implementers."

Women are increasingly on the frontlines in the fight against AIDS, and are benefiting from Uganda's success in countering the disease. HIV rates among pregnant women in urban areas have dropped from a peak of 30 percent in 1992 to 6 percent in 2001.

And it is for the health of Uganda as a country - and as an economy - that the scourge of AIDS be confronted. A country that is poor to begin with, which then loses young workers and spends scarce resources caring for sick people, won't be able to improve living standards.

HIV/AIDS has been estimated to reduce GNP by up to 2 percent annually in hard-hit countries like Uganda. No wonder the 1999 Uganda Poverty Status Report states that "HIV/AIDS poses the most serious challenge to the future success in reducing poverty." With so many workers sick, food production has also been hard hit.

A UN Uganda Human Development Report for 2002 notes that some households with AIDS sufferers spend as much as 61 percent of their income on patient care. Deaths among parents and teachers are hurting the educational prospects for children. Growing numbers of those orphaned by AIDS drop out of school, spurring the government to make education free.

Ugandans have a long road ahead of them - there are still many steps to take to not only tackle the disease, but to also confront the conditions that give rise to it. Many were dismayed to hear President Museveni claim in 2002 that no gay people live in Uganda and that HIV only spreads in three ways in his nation: unprotected sex, careless blood transfusions and tribal customs such as circumcision

And there's a limit to what this impoverished country can do on its own, in the face of such a colossal challenge. Large-scale efforts such as the Global Fund to Fight AIDS, Tuberculosis and Malaria are needed. Africa alone does not have the resources needed to combat the epidemic and to save the lives of those inflicted by AIDS.

To date the Global Fund has received only $2.1-billion, well below the $10-billion experts feel is needed to make a significant impact in the fight against the three killer diseases. The Fund is currently bankrolling 150 programs in 92 countries.

That's why U.S. President George W. Bush's pledge to increase AIDS spending by $15-billion over five years was welcome news. AIDS activists - including Bono, frontman of the popular rock band U2 - were happy that Bush put AIDS in Africa on his map. The musician also applauded the U.S. government's emphasis on treatment as well as prevention, a shift from earlier policy.

There are concerns, however, over how the United States intends to channel the funds. Only $1-billion of the $10-billion will go to the Global Fund. Most of the money, which will start flowing in 2004, is to be managed by the U.S. government and American charities.

"It's troubling that the President gives such short shrift to the Global Fund, which is fast running out resources," says Dr. Paul Zeitz, head of the Global AIDS Alliance. "The Global Fund is the best hope yet for the fight against AIDS and other killer diseases." It gives both the donor and the recipient countries a say in how the money is spent.

And the one billion from America is contingent on other wealthy nations contributing more money to battle AIDS, so the actual amount could be reduced. But at the Group of Eight summit in Evian, France in June 2003, the European Union committed $1-billion (U.S.) a year to the Global Fund. Great Britain announced a one-time donation of $80-million (U.S.) while Canada has promised the multilateral initiative $100-million (U.S.) through to 2005.

Back on the AIDS battleground, anti-retroviral drugs are enabling many people with the disease in affluent countries like Canada to continue living for years. Yet only 30,000 of the 30 million infected people in Africa have access to these life-saving drugs. Museveni has strongly denounced the reluctance of developed countries to make anti-AIDS drugs more widely available in developing countries.

"It is very genocidal for one part of the world to have [treatment] for the AIDS disease while millions of people in another part are dying from the same."

The United Nation's Special Envoy on HIV/AIDS in Africa has gone so far as to accuse the world's rich countries of "mass murder by complacency" for failing to contribute enough money to defeat the disease.

"Why can three trillion U.S. dollars be raised in a matter of weeks for the war on terrorism, but not $65-billion over five years to prevent literally millions of deaths from AIDS?" says the UN's Stephen Lewis.

Yet in the face of the obstacles, Uganda continues to make advances. The Ministry of Health plans to provide free AIDS drugs to all expectant mothers to reduce the risks of infection at birth. Ugandan volunteers are now testing a potential AIDS vaccine specifically developed for the strain of the HIV virus common in east Africa.

"Uganda is leading the way in the search for an AIDS vaccine for Africa," says Professor Francis Omaswa, director general of Uganda's health services.

Uganda is also offering hope for victims of AIDS, and a path for other African nations facing the deadly disease.

Murray MacAdam is a Toronto-based writer specializing in community development and global issues.
Written June 2003.