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Understanding the Uganda Approach to HIV/AIDS Prevention

By 29 June 2004October 8th, 2018News

– Release date: 30 June 2004

What is it?

Since the 1980s the world has looked to Uganda as a model for successfully reducing their rate of HIV/AIDS by implementing an A,B,C approach (A- abstaining from sex, B- being faithful/monogamy, and C- Condom use). The promotion of abstinence from sex has been highlighted as the main cause for this approach’s success. However, it is undetermined to what extent each one of the A, B, C factors has contributed to reducing rates of HIV infection.

What is its relevance to IFPA work?

Internationally, anti-choice movements are citing Uganda as proof of effectiveness of abstinence only education in reducing STI rates.

What facts are known?

According to estimates from UNAIDS/WHO based on surveillance data for pregnant women, Uganda's HIV prevalence declined in major urban areas from about 30% in 1990 to 14% in the late 1990s, and in non-urban areas from 13% in 1992 to about 8% in the late 1990s. As Uganda is a largely rural country, national trends are similar to the situation in non-urban areas.

To better understand the cause of these declines, the Alan Guttmacher Institute data from nationally representative Demographic and Health Surveys in 1988 (of reproductive-age women) and 1995 and 2000 (of women and men) in Uganda to identify changes in sexual activity, multiple sexual partnerships and condom use. These nationally representative data are more relevant for understanding national trends in HIV prevalence than studies that have addressed behavior changes within particular geographic or demographic subgroups. The analysis reveals that:

  • Condom use among unmarried women rose from negligible levels in 1988 to 24% in 2000. Condom use also rose sharply among unmarried men, from 39% in 1995 (the first year of available data) to 57% in 2000. Together, these increases make condoms a significant contributor to lowering risk of HIV infection.
  • Reductions in the number of sexual partners also contributed to reducing exposure to HIV risk. The proportion of unmarried sexually active women who said they had more than one sexual partner within the past year declined from 10% to 4% between 1995 and 2000. (Among unmarried men, the proportion remained steady at about 25%)
  • In 2000, fewer adolescents (especially young women) reported ever having had sex than in the prior survey years, indicating that delayed sexual activity was a moderately important contributing factor in reducing HIV infection risks. Among those who were sexually experienced, however, there was no increase in abstinence.
  • In understanding the results of the Ugandan integrated approach to dealing with HIV/AIDS it is vital to realize that the Ugandan government's program has been comprehensive, encouraging abstinence but also providing information about and support for condom use among those who are sexually active. The evidence from Uganda simply does not support a single-focus, abstinence-only approach to HIV prevention.