Johannesburg — It is accepted AIDS is a cause of death, not myriads of other things

In the depressing frenzy of statistics that often characterises AIDS conferences, there is one success story that defies the stereotype.

Uganda is poor, rural and in sub-Saharan Africa. Those three factors alone should condemn it to being a helpless case in the eyes of the developed world.

Yet, without access to antiretroviral drugs and with limited health infrastructure, this small country has managed to cut its HIV prevalence rate by half (to about 8,3%) and slash the number of new HIV cases 37%. This is according to results of a 10-year study published in this week's edition of the British medical journal The Lancet.

The study involved testing 6566 HIVnegative adults in villages in rural Uganda between January 1990 and December 1999.The drop in new infections was particularly marked among young people between the ages of 13 and 24, the group that is usually associated with risky sexual behaviour.

David Serwadda, a doctor who treated the first AIDS patient in Uganda, says two factors have been key in his country's turnaround. People have cut down on their number of sexual partners and young people are starting to have sex at a later age at 15,5 years rather than 14.

"Those are for me the most significant factors," says Serwadda, who is in Barcelona this week to attend the 14th World AIDS Conference.

For Dr Alex Coutinho who heads The AIDS Support Organisation in Uganda, a nongovernmental group that supports people with HIV/AIDS, the one key factor is individual responsibility.

"People understand that the focus of control of HIV prevention lies with themselves. They understand that they are at risk and are taking personal responsibility to prevent infection. This is really personal emancipation where the focus of control of your life lies with yourself," says Coutinho.

What has made people feel this way, he says, is the fact that so many people have died of AIDS in Uganda that it is "not an academic question".

"We are all touched by it. I have lost nine close relatives. I take care of two AIDS orphans. It has touched us all."

Not only is no one untouched, but there is acceptance that AIDS is the cause of death rather than the myriad of other causes usually listed to obscure AIDS deaths, as happens in SA.

This openness is in large part thanks to the fact that Uganda's President Yoweri Museveni has made HIV/AIDS one of his three personal priorities, alongside peace and economic empowerment, for the past 16 years.

Museveni's commitment created the climate for a partnership between government, civil society and international donors which led to the formation of a multisectoral AIDS Commission.

The commission has driven home the prevention message through massive and sexually explicit education campaigns, HIV surveillance, condom distribution and management of sexually transmitted infections.

In an environment where the president speaks about HIV everyday, it is no wonder that the country's most famous pop star, army officers and an Anglican priest, have felt able to announce to the nation that they were HIV-positive.

"The human face is important," says Coutinho. "It makes people appreciate their risk."