BBC News - Tuesday, 2 December, 2003
Will Ross, BBC, Kampala

When Florence Mohoro was diagnosed with HIV in the early 1990s, HIV prevalence in Uganda was well above 10% and reported as up to 30% in some urban areas.

Doctors gave her two years to live. Eleven years later, living a full life on anti-HIV drugs, she looks back and laughs at the prognosis.

Similarly for the country, although the government says Aids has killed close to a million people and orphaned nearly two million children, the worst predictions have not come to pass.

A massive government education programme from the early 1990s made Uganda the first country in sub-Saharan Africa to reverse its own Aids epidemic.

Florence remembers well the dull-toned drum beats that preceded every news bulletin, followed by the message "Aids kills".

"I was definitely scared, but somehow death seemed to be remote - for somebody else but not me," she recalls.

'Embarrassing disease'

Six years earlier, the then Minister of Health, Doctor Ruhakana Rugunda, had faced harsh criticism from fellow African colleagues when he announced at the World Health Assembly that Uganda faced HIV and Aids.

"They told me I was portraying Uganda and Africa in a bad light by admitting to such an embarrassing disease," he remembers.

The statistics show that this early openness paid off. The Health Ministry now estimates that 6.2% of the population carry the virus.

While doubts have been raised over the accuracy of these figures, there has clearly been a fall in HIV prevalence since the early 1990s and this is evident in localised changes.

For example, figures recorded at an antenatal clinic in central Kampala show a drop from 24.5% being HIV positive in 1989 to 8.5% by 2002.

President Yoweri Museveni made it a government policy to be open about HIV and Aids. He insisted that the topic was included in sex education in schools.

Eroding stigma

Professor Francis Omaswa, the director of health services at Uganda's Health Ministry, is convinced that the government's warning broadcasts worked.

"I have heard many personal testimonies of men who were ready to have sex and then they heard the radio and put their trousers back on," he says.

But it was only when the campaigns began to focus on living positively with HIV and Aids that they began to erode stigma and denial.

Ugandan musician Philly Lutaaya greatly contributed by being one of the first to announce he was HIV-positive.

In 1987, the National Aids Control Programme was launched. In the same year, the widely-respected Aids Support Organisation, known as TASO, was founded by a group of HIV-positive volunteers.

Easy as ABC

The Ugandan approach has been dubbed the "ABC" strategy, with the emphasis firstly on abstinence, then on being faithful and thirdly on condoms.

At the Ministry of Health, Mr Omaswa is quick to claim that condoms have not been the main reason for the drop in HIV rates:

"Condoms have a place in the control of HIV/Aids. But more importantly, the sexual behaviour in Uganda has changed. There is more responsible sex - full stop," he states.

But young people are not so sure. The organisation Straight Talk makes radio programmes and a newspaper for distribution in schools.

At Kitante Hill secondary school, Samuel Nangira, a member of a club set up by Straight Talk, says that few teenagers are abstaining from sex - they prefer to rely on condoms.

Vital drugs

While progress has been made in raising awareness, few people living with HIV and Aids are able to access life-prolonging antiretroviral drugs, even though prices have fallen.

Currently the most common drug combination costs $27 a month.

An estimated 15,000 Ugandans are taking the drugs, but over 150,000 desperately need them.

The Joint Clinical Research Centre is the main supplier of these drugs. Its director, Doctor Peter Mugenyi, is concerned that without an effective information campaign, the drugs will not be used properly and will become less effective as the virus mutates.

"People need to know that these drugs are delicate and if not used correctly, resistance will occur. That danger is real," he warned.

A task force from the Ministry of Health has been addressing this very question, but many health professionals say the country is not well prepared for antiretroviral drugs.

Meanwhile despite being told she only had two years to live Florence Mahoro works energetically for the Aids Information Centre. Her drugs are paid for by a sponsor.

Visit any hospital and it is clear Uganda still faces a mountainous task. An ongoing war in the country is hindering progress.

HIV patients are calling for more support, better access to anti-viral treatment and help with costs for other drugs.

But President Museveni has always maintained that the battle can be won.

In his own words: "[Aids is] not hard to prevent because we know where it comes from. If there is a snake in a hole, why do you put your finger in the hole?"
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