Around 1.1 million people are estimated to be living with HIV/AIDS in Uganda, 120,000 of them children. The Ugandan government is often seen as a model in Africa for fighting the disease. It set up an AIDS control programme as far back as 1987 to educate the public about the disease, promoting an ‘ABC’ approach – Abstain, Be faithful, use Condoms – to reduce infections. And since 2004, antiretroviral drugs have been available free of charge in Uganda to those infected.
Free access to medication has meant that a whole generation of infected children are now surviving and living with the disease, and many of these are moving into their teenage years. Health workers are concerned that some teenagers are acting irresponsibly and infecting other teenagers through unprotected sex. One HIV-positive nineteen-year old admitted to sleeping with a friend without a condom because she was too scared to be honest with him about her status. Some agencies are lobbying for condoms to be supplied through schools, but so far the Ministry of Health and Education has yet to make a decision on this.
The government may feel under pressure on the issue of condoms, since it receives a significant amount of funding from the USA. The US Government has just donated 25 million dollars towards HIV/AIDS treatment and prevention programmes under the Presidential Emergency Programme for AIDS Relief (PEPFAR). Beneficiaries include ten clinics run by Kampala City Council, as well as other organisations such as the Baylor College of Medicine. The PEPFAR grant will be spread amongst a broad group of organisations fighting the disease, including those who provide condoms. But other US-backed aid is funded by Christian groups who want to see messages of abstinence promoted. This could have lead to a shift away from the ‘ABC’ approach, which might be one reason for a slight increase in prevalence of the disease over the last few years.
Religious intervention is certainly to blame for a growing number of teenagers who are abandoning their HIV medication and turning to faith healers. A counsellor at the Baylor College of Medicine (which treats more than 4,000 HIV-infected children) has noted a growing trend of adolescents who withdraw from treatment because they believe themselves cured of HIV/AIDS in church, mostly Pentecostal. One of the counsellor’s young clients was recently dumped back at Baylor after being persuaded by a faith healer to stop taking her medication. They tried to treat the girl, “but it was too late”. Even if young people find their way back to the health system in time, they often require more expensive second-line treatments to recover. Baylor College is trying to work with religious leaders so that youngsters living with HIV/AIDS are correctly supported.
Even if the government has yet to decide on its future approach to supplying condoms through the schools, there are now a wide number of books from local publishers which openly discuss the problem of HIV/AIDS. One book, called ‘How Kwezi Got Into Trouble’, tells the story of a girl who is raped by her father’s best friend and contracts HIV/AIDS. This fiction book is aimed at 8 to 10 year olds and the same series includes a cautionary tale of two 12-year-old boys who contract HIV after having sex with the same infected girl, both boys dying before they reach adulthood. If this seems shocking and brutal for such a young audience, it must be remembered that by tackling the issue of HIV/AIDS so openly over the last three decades, Uganda has had much success in reducing rates of infection. Children make up the largest proportion of the country’s population (in 2009, 49% of Ugandans were below the age of fourteen), so books like these are helping to raise awareness and fight complacency and misinformation among the largest and most vulnerable section of society.