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Uganda: why a re-think is needed of AIDS control policy.


 Uganda has adopted an open policy toward AIDS since the early 1980s when the 1st case of HIV/AIDS were reported in the southern part of the country. Efforts included sero-surveillance to identify HIV positive or AIDS cases; governmental and nongovernmental support services to are for the sick; and providing counseling and anonymous testing for HIV/AIDS. However, these endeavors clashed with ingrained sociocultural and economic factors. In Uganda, women's roles are generally perceived as keeping the house and looking after the interests and needs of the men. Women's participation in decision making on sexuality averages 13% in rural areas and about 36% in urban areas. Prevailing attitudes value children even outside of marriage, and women derive rights from being married. Widow inheritance is regarded as a social obligation to ensure the care for the widow and the orphans. There is a high awareness of risky sexual behavior, but condom acceptability and use is low: a rate of .5%-1.5% for men over 18 years of age. Stigmatization of HIV/AIDS victims is fairly high, and the disease is still spread by casual contact. Although, individual family support is increasing, the community attitude is disdainful towards the family of the victims. The problem is not ignorance, as assumed by most program developers, but entrenched patterns that alternatives can change: messages suggesting less risky behavior. Some 20% of urban respondents had a negative attitude toward the AIDS Support Organization, as in their view prolonging patients lives increased the risk of transmission of HIV/AIDS. The reorientation of the program and gradual change is needed, taking into account variability of practice at individual and community level.
