New York Times - August 30, 2005
Lawrence K. Altman

But the charges were disputed by the Ugandan government and an official of President Bush's emergency plan for AIDS relief, known as PEPFAR. The plan emphasizes a policy known as ABC, which stands for abstinence, be faithful and use condoms.

The dispute comes less than a week after the Global Fund to Fight AIDS, Tuberculosis and Malaria, a public-private partnership based in Geneva, suspended $201 million in grants to Uganda because of government mismanagement.

In a telephone conference with reporters, the critics said that Uganda needed 120 to 150 million condoms a year but that this year's supply of fewer than 30 million condoms, to be distributed at health clinics, had been exhausted. Privately purchased condoms have more than tripled in price in Uganda, from 16 cents to 54 cents for a package of three, making them unaffordable for many Ugandans, the critics said.

Jodi Jacobson, executive director of the Center for Health and Gender Equity, in Washington, one of the groups criticizing U.S. policy, said that "there has been a dangerous and profound shift in U.S. donor policy from comprehensive prevention, education and provision of condoms to focus on abstinence only." The shift denies information and technologies to people at greatest risk of HIV, she said.

Condoms have become difficult to find in cities, even for a price, and are unavailable in many rural areas, the critics said, and some men have begun using garbage bags as condom substitutes to prevent HIV infection.

Ambassador Stephen Lewis, the U.N. secretary-general's special envoy for HIV-AIDS in Africa since 2001 and the former Canadian ambassador to the United Nations, said that "there is no question that the condom crisis in Uganda is being driven and exacerbated by PEPFAR and by the extreme policies that the administration in the United States is now pursuing."

Lewis said that the emphasis on abstinence in the administration's program, even more than the issue of condom distribution, is a "distortion of the preventive apparatus and is resulting in great damage and undoubtedly will cause significant numbers of infections which should never have occurred."

The Ugandan government is providing condoms mainly to sex workers and truck drivers, the two groups who are considered at highest risk.

However, Lewis said, "How do you save married women, who have no choice?"

"It is the ultimate irony that the country and the political leadership most dramatically associated with the decline in prevalence rates is now in a position of attacking one of the strongest preventions we have," Lewis said, referring to the fact that Uganda had been praised in the past for its AIDS prevention programs.

Lewis said he had not discussed the condom issue directly with representatives of the presidential program.

Jacobson said that, last October, Uganda had issued a nationwide recall of the Ugandan brand of condoms, contending that they were of poor quality, causing a shortage. The government also levied new taxes on imported condoms.

Beatrice Were, of Action Aid in Uganda and the Health Rights Action Group, said, however, at the teleconference that tests performed on the condoms in the United States found them safe and effective. She and other critics said that religious groups in Uganda had used the initial claims to undermine confidence in condoms and contribute to misinformation about their effectiveness.

But Dr. Mark Dybul, the deputy U.S. global AIDS coordinator and chief medical officer, said in a telephone interview that U.S. officials in Uganda had told him Monday that there was no current shortage in condoms there, but that there could be one if the country did not receive current orders.

The Bush administration has supported the purchase of 15 to 20 million condoms that are in a warehouse in Uganda awaiting further testing "to tide them over" if there is a shortage, Dybul said.

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