Your daily Selection of IRIN Africa PlusNews reports, 12/4/2006

[Guest guest]

U N I T E D N A T I O N S

Office for the Coordination of Humanitarian Affairs

Integrated Regional Information Network (IRIN) -

[These reports do not necessarily reflect the views of the United Nations]

CONTENT:

1 - UGANDA: An HIV/AIDS campaign in crisis?

1 - UGANDA: An HIV/AIDS campaign in crisis?

KAMPALA, 4 December (PLUSNEWS) - Uganda's success in lowering its HIV/AIDS

level, lauded as a rare African achievement, could be unravelling. The latest

UNAIDS statistics show rising prevalence, and questions are being asked about

the government's commitment to fighting the epidemic.

The 2006 UNAIDS epidemic update revealed that Uganda's prevalence rose

marginally to 6.7 percent in 2005.

Neighbouring countries remained silent about HIV/AIDS in the 1990s when

President Yoweri Museveni's administration took an open and aggressive stance

against the epidemic, which paid off when infection rates tumbled from a peak of

more than 20 percent to a low of 6.4 percent in 2000.

The health ministry has recently appeared to be in a state of crisis: there was

a nationwide shortage of condoms after the government imported defective condoms

in 2004, and life-prolonging antiretroviral drugs worth an estimated $500,000

expired in government stores in September 2006, a blunder activists said was

" inexcusable " when Ugandans were dying from AIDS-related complications.

Positive developments, such as the country exceeding its targets for

antiretroviral (ARV) rollout, have been overshadowed by high-profile corruption

scandals involving the diversion of millions of dollars in AIDS grants from the

Global Fund to fight AIDS, Tuberculosis and Malaria.

The Global Fund temporarily suspended grants worth US$367 million to Uganda in

August 2005, citing " serious mismanagement " of funds; the grants were reinstated

three months later. Museveni appointed a judicial commission of inquiry in 2006,

which recommended that three former health ministers undergo further questioning

with a view to prosecution for perjury, causing financial loss and uttering

false statements.

Despite the fact that the ministers were dropped from the cabinet, no charges

have yet been brought, causing donor countries to urge the government to take

" expeditious " action against those accused of mismanagement.

To make matters worse, the Global Fund excluded Uganda from the list of

countries receiving funds in its current round of grants for HIV/AIDS and

malaria, and the country will only receive funds for combating TB in this grant

year.

As Uganda joined the rest of the world in celebrating World AIDS Day on 1

December, questions remain as to the direction of the country's HIV/AIDS

response, and activists are calling for the government to be held accountable

for the misuse of Global Fund aid.

" This money went into politics instead of helping people; the governing leaders

must explain exactly what happened, " said Rubaramira Ruranga, an HIV-positive

former army major and the founder of an NGO for people living with HIV/AIDS.

Uganda's new health minister, Dr Malinga, told PlusNews his ministry was

developing a new system for channelling funds, and would have the " strictest

possible attitude " to the use of donor money in future.

He suggested that the spike in prevalence could be attributed to " complacency " .

ARVs were now becoming more widely available, allowing HIV-positive people to

live longer, which was somewhat blunting the message that AIDS was a

life-threatening condition. " Some people mistakenly believe that ARVs are a cure

when they are not, " he added.

Ruranga agreed. " There is so much complacency, " he said. " People don't feel as

vulnerable as they used to feel in the past, and when they forget the risks, we

know what happens. "

There are still wide disparities between rural and urban HIV service provision.

" There are so many claims being made about drugs and services being provided but

when you actually go and look, particularly in rural areas, it's not actually

working, " said Ruranga. " People are coming from across the country to Kampala in

search of their drugs. They spend money they don't have to get here, and many

others are forced to give up. "

Malinga acknowledged the gap, and said his ministry would be paying greater

attention to people living in rural areas. " That's where the frontline is now, "

he said.

Some analysts have also blamed the loss of momentum in the struggle against AIDS

on the apparent change in strategy from the well-established ABC - Abstinence,

Be Faithful and use a Condom - to emphasising abstinence over condom use, an

approach favoured by First Lady Janet Museveni.

ABC was widely credited with helping bring down Uganda's prevalence, but a shift

to the religious right - brought about, some say, by the desire to access

funding from US President's Bush's Emergency Plan For AIDS Relief (PEPFAR) - has

seen the 'C' become increasingly condemned as promoting promiscuity and

permissiveness.

Beatrice Were, co-founder of the National Community of Women Living with AIDS

support group, and now HIV/AIDS coordinator for ActionAid International,

believes infection rates are creeping up because " the political will has

dwindled ... Museveni has stopped listening to voters with HIV and increased the

stigma by giving a platform to evangelical radicals. "

Ruranga echoed the view. " When you get the wife of the president and other

senior people actually discouraging condoms, people listen, " he said. " They

think, 'who else knows better than them'? "

Pastor Ssempa, who regularly organises pro-abstinence rallies at Makerere

University, in the capital, Kampala, said the emphasis had moved too far in the

direction of condoms. " We don't have to say C every time we say A and B, " he

insisted.

The government has always denied changing its strategy from ABC, but new data

from the UNAIDS epidemic update suggests that people haven't stopped having

casual sex, but are now less likely to use protection. Around three-quarters of

men aged 15-24 had casual sex in the last year and, worryingly, only half the

men and women between 15 and 49 years old reported using a condom the last time

they had sex with a casual partner.

" The only policy change [needed] now is to be even more aggressive, " said

minister Malinga. " Do condoms play a part of that? Yes, there needs to be a role

for both condoms and abstinence concurrently. "

Dr Bernard Etukoit, ARV coordinator at The AIDS Support Organisation, one of

Uganda's oldest AIDS NGOs, said a period of reflection from those working in the

field was required.

" There has to be a review, and that is taking place now. We need to go back to

where we began and see where we impacted well in the past, " he said. " We have to

go back to the roots. "

ed/kr/kn/he/oa[ENDS]

Your input is important. Please complete our annual survey at

http://www.irinnews.org/readership_survey.aspThis is non-reply e-mail. Please do

not hesitate to contact us at Mail@....

Principal donors: IRIN is generously supported by Australia, Canada, Denmark,

ECHO, Japan, Netherlands, Norway, Sweden, Switzerland, the United Kingdom and

the United States of America. For more information, go to:

http://www.IRINnews.org/donors

[This item comes to you via IRIN, a UN humanitarian news and information

service, but may not necessarily reflect the views of the United Nations or its

agencies. All IRIN material may be reposted or reprinted free-of-charge; refer

to the copyright page (Http://www.irinnews.org/copyright ) for conditions of

use. IRIN is a project of the UN Office for the Coordination of Humanitarian

Affairs.]

PLUSNEWS

Tel: +27 11 895-1900

Fax: +27 11 784-6759

Email: Mail@...

To make changes to or cancel your subscription visit:

http://www.irinnews.org/subscriptions

Subscriber: AIDS treatments

[Guest guest]

U N I T E D N A T I O N S

Office for the Coordination of Humanitarian Affairs

Integrated Regional Information Network (IRIN) -

[These reports do not necessarily reflect the views of the United Nations]

CONTENT:

1 - UGANDA: An HIV/AIDS campaign in crisis?

1 - UGANDA: An HIV/AIDS campaign in crisis?

KAMPALA, 4 December (PLUSNEWS) - Uganda's success in lowering its HIV/AIDS

level, lauded as a rare African achievement, could be unravelling. The latest

UNAIDS statistics show rising prevalence, and questions are being asked about

the government's commitment to fighting the epidemic.

The 2006 UNAIDS epidemic update revealed that Uganda's prevalence rose

marginally to 6.7 percent in 2005.

Neighbouring countries remained silent about HIV/AIDS in the 1990s when

President Yoweri Museveni's administration took an open and aggressive stance

against the epidemic, which paid off when infection rates tumbled from a peak of

more than 20 percent to a low of 6.4 percent in 2000.

The health ministry has recently appeared to be in a state of crisis: there was

a nationwide shortage of condoms after the government imported defective condoms

in 2004, and life-prolonging antiretroviral drugs worth an estimated $500,000

expired in government stores in September 2006, a blunder activists said was

" inexcusable " when Ugandans were dying from AIDS-related complications.

Positive developments, such as the country exceeding its targets for

antiretroviral (ARV) rollout, have been overshadowed by high-profile corruption

scandals involving the diversion of millions of dollars in AIDS grants from the

Global Fund to fight AIDS, Tuberculosis and Malaria.

The Global Fund temporarily suspended grants worth US$367 million to Uganda in

August 2005, citing " serious mismanagement " of funds; the grants were reinstated

three months later. Museveni appointed a judicial commission of inquiry in 2006,

which recommended that three former health ministers undergo further questioning

with a view to prosecution for perjury, causing financial loss and uttering

false statements.

Despite the fact that the ministers were dropped from the cabinet, no charges

have yet been brought, causing donor countries to urge the government to take

" expeditious " action against those accused of mismanagement.

To make matters worse, the Global Fund excluded Uganda from the list of

countries receiving funds in its current round of grants for HIV/AIDS and

malaria, and the country will only receive funds for combating TB in this grant

year.

As Uganda joined the rest of the world in celebrating World AIDS Day on 1

December, questions remain as to the direction of the country's HIV/AIDS

response, and activists are calling for the government to be held accountable

for the misuse of Global Fund aid.

" This money went into politics instead of helping people; the governing leaders

must explain exactly what happened, " said Rubaramira Ruranga, an HIV-positive

former army major and the founder of an NGO for people living with HIV/AIDS.

Uganda's new health minister, Dr Malinga, told PlusNews his ministry was

developing a new system for channelling funds, and would have the " strictest

possible attitude " to the use of donor money in future.

He suggested that the spike in prevalence could be attributed to " complacency " .

ARVs were now becoming more widely available, allowing HIV-positive people to

live longer, which was somewhat blunting the message that AIDS was a

life-threatening condition. " Some people mistakenly believe that ARVs are a cure

when they are not, " he added.

Ruranga agreed. " There is so much complacency, " he said. " People don't feel as

vulnerable as they used to feel in the past, and when they forget the risks, we

know what happens. "

There are still wide disparities between rural and urban HIV service provision.

" There are so many claims being made about drugs and services being provided but

when you actually go and look, particularly in rural areas, it's not actually

working, " said Ruranga. " People are coming from across the country to Kampala in

search of their drugs. They spend money they don't have to get here, and many

others are forced to give up. "

Malinga acknowledged the gap, and said his ministry would be paying greater

attention to people living in rural areas. " That's where the frontline is now, "

he said.

Some analysts have also blamed the loss of momentum in the struggle against AIDS

on the apparent change in strategy from the well-established ABC - Abstinence,

Be Faithful and use a Condom - to emphasising abstinence over condom use, an

approach favoured by First Lady Janet Museveni.

ABC was widely credited with helping bring down Uganda's prevalence, but a shift

to the religious right - brought about, some say, by the desire to access

funding from US President's Bush's Emergency Plan For AIDS Relief (PEPFAR) - has

seen the 'C' become increasingly condemned as promoting promiscuity and

permissiveness.

Beatrice Were, co-founder of the National Community of Women Living with AIDS

support group, and now HIV/AIDS coordinator for ActionAid International,

believes infection rates are creeping up because " the political will has

dwindled ... Museveni has stopped listening to voters with HIV and increased the

stigma by giving a platform to evangelical radicals. "

Ruranga echoed the view. " When you get the wife of the president and other

senior people actually discouraging condoms, people listen, " he said. " They

think, 'who else knows better than them'? "

Pastor Ssempa, who regularly organises pro-abstinence rallies at Makerere

University, in the capital, Kampala, said the emphasis had moved too far in the

direction of condoms. " We don't have to say C every time we say A and B, " he

insisted.

The government has always denied changing its strategy from ABC, but new data

from the UNAIDS epidemic update suggests that people haven't stopped having

casual sex, but are now less likely to use protection. Around three-quarters of

men aged 15-24 had casual sex in the last year and, worryingly, only half the

men and women between 15 and 49 years old reported using a condom the last time

they had sex with a casual partner.

" The only policy change [needed] now is to be even more aggressive, " said

minister Malinga. " Do condoms play a part of that? Yes, there needs to be a role

for both condoms and abstinence concurrently. "

Dr Bernard Etukoit, ARV coordinator at The AIDS Support Organisation, one of

Uganda's oldest AIDS NGOs, said a period of reflection from those working in the

field was required.

" There has to be a review, and that is taking place now. We need to go back to

where we began and see where we impacted well in the past, " he said. " We have to

go back to the roots. "

ed/kr/kn/he/oa[ENDS]

Your input is important. Please complete our annual survey at

http://www.irinnews.org/readership_survey.aspThis is non-reply e-mail. Please do

not hesitate to contact us at Mail@....

Principal donors: IRIN is generously supported by Australia, Canada, Denmark,

ECHO, Japan, Netherlands, Norway, Sweden, Switzerland, the United Kingdom and

the United States of America. For more information, go to:

http://www.IRINnews.org/donors

[This item comes to you via IRIN, a UN humanitarian news and information

service, but may not necessarily reflect the views of the United Nations or its

agencies. All IRIN material may be reposted or reprinted free-of-charge; refer

to the copyright page (Http://www.irinnews.org/copyright ) for conditions of

use. IRIN is a project of the UN Office for the Coordination of Humanitarian

Affairs.]

PLUSNEWS

Tel: +27 11 895-1900

Fax: +27 11 784-6759

Email: Mail@...

To make changes to or cancel your subscription visit:

http://www.irinnews.org/subscriptions

Subscriber: AIDS treatments