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Uganda's AIDS success questioned
A praised drop in cases may have more to do with deaths than changed behavior, researchers said. - David Brown - Washington Post (posted to Internet February 34, 2005)

BOSTON - Abstinence and sexual fidelity have played virtually no role in the much-heralded decline of AIDS rates in the most closely studied region of Uganda, researchers told a gathering of AIDS scientists here yesterday.

Instead, it is the deaths of previously infected people, not dramatic change in human behavior, that is the main engine behind the ebbing of the overall rate, or prevalence, of AIDS in southern Uganda over the last decade, they reported.

The findings, not yet published, contradict earlier studies that attributed Uganda's success in AIDS prevention largely to campaigns promoting abstinence and faithfulness to sex partners. Much of the prevention work in the Bush administration's $15 billion global AIDS plan is built around those two themes, and Uganda is frequently cited as evidence that the strategy works.

If the report here stands up to scrutiny - and, more important, is borne out by surveys elsewhere in Uganda - it will deflate one of the few supposed triumphs to come out of AIDS-battered Africa in the last decade. The success of Uganda's ABC strategy - the letters stand for Abstinence/Be faithful/use Condoms - has been widely touted and is on the verge of being exported to its neighbors with the help of American money.

"There is an urgent need to assess abstinence and monogamy in other parts of Uganda," said Maria Wawer, a physician at Columbia University's Mailman School of Public Health who presented the data at the 12th Conference on Retroviruses, the annual midwinter AIDS meeting in the United States.

She and her colleagues found that the one prevention technique whose use did increase between 1994 and 2003 was condoms - the part of the ABC triad that has been relatively deemphasized in the Bush plan.

"Abstinence and monogamy are very good behaviors," she said in a news briefing after her presentation. "On the other hand, the data support that in this setting, the behavior that seems to have been the easiest to increase over time is condom use."

President Bush and administration officials have repeatedly cited Uganda's experience in promoting their approach. "We can learn from the experience of other countries when it comes to a good program to prevent the spread of AIDS, like the nation of Uganda," Bush said last June in Philadelphia, adding that the ABC program was "a practical, balanced and moral message."

Wawer's findings come from a study of 10,000 people aged 15 to 49 who live in 44 villages near Uganda's border with Tanzania. Each year researchers have gone door-to-door collecting blood and urine samples and asking about health and behavior. About 85 percent of residents cooperate with the study, which over the years has grown to include AIDS treatment and prevention services as well as research.

Uganda is one of the 15 "target countries" in the Bush AIDS program, formally known as the President's Emergency Plan for AIDS Relief.