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Uganda: ABC Strategy Not Enough in HIV Fight
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New Vision (Kampala)
OPINION
6 April 2008
Posted to the web 7 April 2008
Joshua Lubandi
Kampala
THE fifth National AIDS Conference took place at Speke Resort Munyonyo recently. The theme was "Evidence-driven action for greater success" with the slogan, "Moving beyond past achievements." Moving beyond the past achievements calls for going beyond the ABC (Abstinence, Be faithful and Condoms) strategy.
The ABC strategy led to the reduction in the HIV prevalence rate from 18% in 1992 to 6.4 % by 2006. However, there is still a long way to go.
About 2.5 million Ugandans are HIV-positive and 2.3 million children have been orphaned by HIV/AIDS. The challenges of ensuring universal access to care and treatment by those affected by the pandemic, responding to the needs of orphans and minimising the infection rates, call for a multi-dimension approach beyond the ABC strategy.
The ABC strategy focuses more on changing sexual behaviours and ignores social-cultural and economic dimensions that put certain categories of people to a higher risk of getting infected.
It is premised on assumptions that every person is empowered to make free choices regarding their sexual behaviours. But poverty, gender imbalances, sexual violence and negative cultural practices deny some people a choice to control their sexual behaviours.
Different communities have different values and practices that sanction one's ability to abstain, use a condom or be faithful to their partners. For instance, an adolescent Pokot girl has to go through female genital mutilation as a cultural obligation after which she is considered ripe for sex and marriage. This girl can hardly apply the ABC choices.
Such cultural practices do not only put the young girl's life at risk of contracting HIV, but also lead to early marriages, unwanted pregnancies and instabilities in families which subsequently increase the chances of HIV infections.
In some communities like the Karimojong, forcefully having sex with women is seen as a normal practice, especially if it is being done for the first time.
The Sebei in eastern Uganda frequently marry by elopement, sometimes done against the wish of the women. In the event of sexual violence like defilement or rape, neither the offender nor the victim can think of a condom as an alternative to prevent HIV infections.
During times of scarcity, parents in some communities look upon their daughters as an alternative source of wealth and food. They force their daughters to get married at a tender age in exchange for money or material wealth in form of dowry. This increases the girls' chances of getting infected.
The social controls imposed on women's movement, the submissiveness of women and the unequal power relations within the household create challenges of access to medical care and rightful information.
Most women, children and people living in hard-to-reach areas like Karamoja and Rwenzori have limited opportunities regarding effective preventive and responsive interventions related to HIV/AIDS. The current massages on HIV/AIDS are too general, rotating around the three choices under ABC.
These messages target children and adults equally. Whereas such messages reach everyone, they change none. There is need to tailor the messages to specific audiences like the widows, single parents, working children and pastoralists, putting into consideration their socio-economic needs.
Relying on ABC as a prevention strategy means leaving out the powerless and vulnerable members of society. This partially accounts for the stagnating prevalence rate of 6.4%.
There is need to supplement the ABC strategy with approaches that target contextual and societal issues that dispose vulnerable groups to HIV/AIDS. The strategy should go beyond ABC to DEFG where D stands for fighting discrimination, E for education and information, F for fighting poverty and G for gender sensitivity.
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The writer is the programme officer for Information at ANPPCAN Uganda Chapter
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