UNAIDS Press Release - February 2, 2005
Ruben Prado

When a lion comes into your village, you must raise an alarm loudly. This is what you did in Uganda. you took AIDS seriously and achieved good results.

At the beginning, advertisements were used after the TV news, quietly telling people to "love carefully". But TV was accessible to only a few.

This was a silent alarm. You than realised that the best channels for making an alarm were the political leaders. President Yoweri Museveni himself rose to the challenge and called on all the people of Uganda to unite in a massive population-led AIDS response. Churches and mosques were another crucial avenue for raising awareness. Schools were also asked to pass on the message, once a week during assemblies.

Radio was increasingly used to pass on the message, guaranteeing that almost everyone was reached. The language used and the timing were crucial.

Much was in vernacular, clearly expressed and at times when people were listening. In 1986 when the current government reclaimed Uganda from more than two decades of dictatorial regimes, AIDS was already rampant in some parts of the country.

At a time when most African nations were in denial about the epidemic, you chose to confront the situation. That was leadership! And as a result, Ugandans have turned the epidemic around.

Openness brings about increased involvement, increased funding, increased partnerships. When you were talking about AIDS, the international community said, "Why should we take money to such and such a country that is quiet, let us help Uganda because Uganda is accepting the problem".

And now, in 2005, Uganda has one of the highest levels of external financial AIDS support in the world. The challenge is to make that money work. Openness must happen at various levels. In Africa, where religion is important and has a lot of power, the churches, the mosques, the temples had to be prepared to be open to the AIDS problem.

Taking an open approach was not very easy but it was a precondition for Uganda's success. This was also important to fight fear and stigma, prejudice and discrimination. It facilitated discussions - in Uganda, the issue of condoms had brought problems for the churches. You then introduced a method called 'combination prevention.'

Uganda has reduced the HIV prevalence from about 18% in the early 90s to about 6% today, but if you ask someone, what has brought it about? Is it abstinence, faithfulness or condoms?

No one will give you one answer because you have done a combination approach and all of these, and many more other initiatives, have brought it about.

You also agreed, many years ago, that if you are not comfortable talking about condoms, don't talk about them but don't stop the other person talking about them. Promote what you are comfortable with.

In Uganda every organisation, public and private, and every willing person was recruited in the fight against AIDS. Today, there are more than 2000 organisations engaged in one way or another, including community and faith-based organisations, and the success of these efforts has been tremendous.

You are now still facing an unacceptably high prevalence in Uganda: six in 100 people are infected with HIV. The worst thing that could happen to Uganda now is to fall into complacency, because of your early accomplishments. That will be a disaster.

Leadership and political commitment must be measurable, such as budget allocations to prevention, treatment and care, with constant measuring of AIDS programme activity and results.

Compliance with international treaties and commitments needs to be monitored, such as those that were made at the United Nations General Assembly Special Session on HIV and AIDS (UNGASS) in June 2001.

And leadership must be held accountable for keeping these promises. Leadership must also come from the ground up - communities must call for national action by politicians and bureaucrats!

To make this work better, communities should share their experiences with other communities. Frontline workers should share their experiences with their peers who face similar problems under different conditions. Local governments should encourage these exchanges, structuring the process so that political decision makers also have access to documented experiences. This should lead to greater political commitment and a more vigorous and coherent national response.

In addition to political commitment and leadership, improving governance and accountability will increase the effectiveness and efficiency of AIDS programmes.

Leaders are ultimately responsible to the people for the decisions they make and how they implement them.

In Uganda, this combination of leadership from the highest Office in the land, throughout society, including civil society, religious and cultural leaders û and accountability and good governance, is reflected in the Uganda AIDS Commission, as the coordinating authority for the multisectoral, multidimensional and multilevel HIV and AIDS response; supported in its coordination tasks by the Uganda AIDS Partnership.

The concept of multi-sectoriality with many players at all levels, was discovered and groomed in Uganda, as early as in the 1990s and is now being promoted throughout the world.

When supported in practice by "One AIDS Action Framework, driving alignment of all partners; One National AIDS Authority, with a broad-based multisectoral mandate, and One agreed country-level Monitoring and Evaluation System," as is the case in Uganda, you will be able to have a strong and effective response, bringing the AIDS prevalence down below the stagnating six percent and preventing new infections. In addition to the 'triple therapy' of ABC and other prevention options there is need for good public health practices and rights-based and pro-poor approaches to AIDS.

I have been the UNAIDS Country Coordinator in Uganda for a little over two years and I have now been reassigned to India - a country with over 1 billion people and an estimated five million persons living with HIV. Uganda has been the best institute of learning that I have ever had.

Thank you Uganda, for being my home and my school. I have made many friends here and also a few adversaries. The latter I wish to remind that in the history of the world, fundamentalist and tribal thinking has never led to progress and development. Move on Uganda, on to your second generation of success and continue as a beacon of hope...And to all of you that I worked with closely, I say with the words of Kahil Gibran: "Reason ruling alone is a force confining, and passion unattended is a flame that burns to its own destruction. Therefore, let your soul exhalt your reason to the height of passion, that it may sing ..."

The writer is UNAIDS Country Coordinator in Uganda

050202
UN050201

Copyright © 2005 - Joint United Nations Programme on HIV/AIDS (UNAIDS). All rights reserved. UNAIDS articles, which are not formal publications of UNAIDS, may be freely reviewed, quoted, reproduced or translated, in part or in full, provided the source is acknowledged. The documents may not be sold or used in conjunction with commercial purposes without prior written approval from UNAIDS (contact: UNAIDS Information Centre).

AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb Company, Elton John AIDS Foundation, the National Library of Medicine, Roche and Trimeris, and donations from users like you. Always watch for outdated information. This article first appeared in 2005. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2005. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .