InterPress News Service (IPS); Tuesday, 9 July 1996.
Yvette Collymore

Brought to this Canadian west coast city by the host government for the Jul 7-12 conference, they repeatedly hear health experts say that the East African country is a model on the continent and the developing world for AIDS care.

Indeed, various studies show that the level of awareness about HIV/AIDS in Uganda has reached 80 per cent, and this because of a successful anti-AIDS campaign over the past few years.

But while huge strides have been made in raising awareness about the disease among Uganda's 20 million people, these women say underlying socio-economic factors that place thousands of their fellow Ugandans at risk, still exist -- mainly that a woman is not in a position to say "no" to unsafe sex.

Milly Nanla, 31, does not speak of Uganda's celebrated gains, nor does she serenade the potential benefits of the new, and costly triple-drug therapy -- that scientists and sponsoring companies claim can suppress the human immunodeficiency virus (HIV) more effectively than previous treatments.

Instead, the typist from Mbale, 160 miles east of Kampala, speaks of her poverty and of the need for proper targeting of assistance to her community so that others like her would gain some independence through income-generating projects.

"People have information in Uganda about AIDS," says Nanla, whose country still struggles fiercely to halt the spread of the AIDS-causing HIV virus. "Women know what they are supposed to do but can't implement these things, because they don't know their rights."

A lack of education, self-finance and job availability leave women vulnerable in Uganda's traditionally male-dominated society. As such, they are able to exercise their rights even if they do know how to protect themselves from sexually transmitted diseases (STDs).

The Ugandan case is not an isolated one and the issue came up for much attention during last year's global women's conference held in Beijing.

In recognition of the constraints which coexist with the social subordination of women, The Platform for Action developed there called for steps to be taken in the creation of social and economic empowerment of women and girls, and for programmes to enable men to assume their responsibilities.

The problems however clearly remain Uganda and perhaps represent the largest fly in the ointment as the East African nation limps ahead the rest of Africa in AIDS care.

Uganda, with a Gross Domestic Product (GDP) of some 160 dollars per head, where the vast majority of citizens depend on subsistence farming, has made some leaps since the first AIDS cases there were recognised in 1992.

According to a paper presented to the AIDS conference by Ugandan physician, Dr Elizabeth Madraa, recent studies show declining levels of HIV/AIDS prevalence among mothers attending antenatal clinics in some areas.

Madraa, Programme Manager of the STD/AIDS Control Programme in the Ugandan Ministry of Health, says surveys in five districts found that 68 per cent of the respondents reported behavioural changes in response to AIDS in the last five years. Changes cited included "sticking to one partner", abstinence and condom use.

Madraa and others however say that while the awareness programme has largely been a success, they are well aware that deep-rooted cultural and socio-economic realities make some more vulnerable than others to contracting the disease -- even if they are well aware of the dangers of unprotected sex.

"I always feel I got infected because I didn't know my rights," said Nanla, who adds that women are generally unable to force their husbands or partners to wear condoms.

Dorothy Blake, who directs the World Health Organisation (WHO) Office of HIV/AIDS and Sexually Transmitted Diseases, also points to "the disease of inequality in accessing care and treatment" which she describes as "a real and potent" illness.

But the gender discrepancies in the bid to control the spread of AIDS go far beyond the bedroom. At the international level, women complain that they largely remain outside of the planning committees of international conferences.

The International AIDS Society's Women's Caucus, formed five years ago at the Eighth International AIDS Conference to promote networking among women's groups, says there is still far to go.

"There is a frustration that women's agendas are not included in the mainstream of many conferences," said Prof. Lars Kallings, Secretary-General of the International AIDS Society, based in Sweden.

Too often, he said, women are seen as transmitters of the disease. "It's often considered that you prevent infections in women as a way of preventing infections in men and children."

The disease, first recognised among homosexual men in the United States in 1981, is now spread mostly through heterosexual contact, with 90 per cent of the cases now residing in developing world.

According to UNAIDS -- the Joint United Nation Programme on HIV/AIDS -- sub-Saharan Africa is the only region in which more women are infected than men. The disease affects 13.3 million adults in Sub-Saharan Africa, and women account for slightly more than half of all infected adults.

For Nanla and the other 44 Ugandan women attending this week's conference, word of a possible breakthrough in the treatment of AIDS, is not causing much excitement.

Nanla, a single parent, sells creams to pay for her daughter's schooling as she continues to appeal for start-up funds for a small business.

Even if scientists do development a means of treating the disease, she and millions more in the developing world who have HIV/AIDS would not be able to afford the therapy which initial reports suggest would cost upwards of 12,000 dollars.

UNAIDS chief Peter Piot is well aware of the dilemma and stresses the "absolute need for new technology", that would some way make it possible to make any treatment accessible to all those infected with the deadly virus. (END/IPS/WD-HE-PR-HD/YC/CPG/96)

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