Two reports analysing HIV/AIDS in Uganda a decade apart (2)
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Thanks to John Kiwanuka Ssemakula for alerting us to:
>
> "UCSF Multidiscplinary Analysis of HIV/AIDS in Uganda"
> http://ari.ucsf.edu/ARI/policy/countries.htm
>
I have some questions about this paper. Maybe authors Lisa Gar-
bus and Elliot Marseille read AFRO-NETS and will respond.
In one place we read:
"In 2000-01, when respondents were asked to spontaneously name
methods to avoid HIV infection, the top methods named were using
condoms (mentioned by 54.4 percent of women and 72.3 percent of
men), abstaining from sexual relations (49.7 percent of women
and 65.4 percent of men), and limiting sex to one partner/ stay-
ing faithful to one partner (49.0 percent of women and 43.0 per-
cent of men).[41] These figures represent substantial increases
from the 1995 UDHS, when 21.4 percent of women and 32.0 percent
of men mentioned condoms; 34.2 percent of women and 36.5 percent
of men mentioned abstinence.[117]"
The ref. here is the UDHS 2000-2001.
The figures for condoms in 1995 are exaggerated (its 17% of un-
married men -- and 1.7% of all categories of women). Although
they don't mention it for 1995, "Restricted Sex to One Partner"
is the overwhelming response. These authors leave this out and
frame their analysis in the very American "condoms versus absti-
nence" debate.
More disturbing is where they got their 2001 data, since this
open-ended question was dropped from all DHS questionnaires in
2000. I refer to "Since you heard of AIDS, have you changed your
sexual behavior to prevent getting AIDS?" then, "If so, in what
ways?" The reported responses to these questions are not in the
UDHS report of 2000-2001.
The only 2000-2001 Ugandan data related to these 2 related ques-
tions that I am aware of is from the Uganda MoH, from its popu-
lation based KABP Surveys. These findings show that "Restricted
Sex to One Partner" is still the overwhelming response.
The authors write approvingly of "Â…the gradual buildup and so-
cial acceptability of interventions like condom promotion in the
media and public places without hindrances from religious
groups. A key to this acceptance has been the A, B, C campaign
where condoms are seen as an alternative to abstinence and
faithfulness. Social marketing of condoms has been very success-
ful allowing especially the youth to accept that safe sex can be
fun sex."
It is noteworthy that the ABC approach is described as a way to
add condoms to the prevailing AIDS prevention program. In much
of the world of Global AIDS today, ABC is seen as a way to di-
minish the role of condoms and add the A and B elements. This
underscores how central A and B were in Uganda's early program,
and how marginal A and B have been almost everywhere else.
The UCSF study authors repeat the old arguments about the dan-
gers of using WHO/GPA data (or any other data from the 1980s).
They should read the recent Low-Beer and Stoneburner paper, or
my book "Rethinking AIDS Prevention", Uganda chapter. There are
a number of surveys other than DHS worth consulting. Little can
be learning by restricting oneself to the 1995 and 2000 DHS.
Edward C Green
Harvard School of Public Health
mailto:EGreendc@aol.com