How Has Uganda Managed to Reduce the Growth Rate of HIV-AIDS - Essay Example

Running head: How has Uganda managed to reduce the growth rate of HIV/AIDS How has Uganda managed to reduce the growth rateof HIV/AIDS By _______________________ How has Uganda managed to reduce the growth rate of HIV/AIDS Uganda has been one of the few African countries to declare AIDS as a national problem and open its doors towards international agencies to help fight against HIV. This policy of openness and willingness to cooperate with international health agencies has produced a range of information on Uganda's health situation. The national response towards AIDS awareness, which started between 1982 and 1986, is considered as mainly responsible in managing the reduction of growth rate of AIDS as Uganda is one of the first few countries to experience and recognise the presence of HIV/AIDS in 1982. (2006a) "Its people had the highest HIV infection rates in the world. Over 1.5 million children have been orphaned since the epidemic began losing their mother or both parents to AIDS. However, a structured government response began in 1986 that involved collaboration with international organizations and NGOs has resulted in reversal of serious prevalence rates". (Uganda and HIV) AIDS ultimately has its greatest impact on young women with infections among adolescent women aged 15-19 years old were 10 times higher than among males of the same age. "The national response was largely confined to the health sector and was mostly responsible for making Ugandans think of the disease as witchcraft and later a disease of the immoral, which led to high levels of PHA stigmatization". (2006b) "When the National Resistance Movement assumed power in 1986 it established the AIDS Control Program (ACP) in the Ministry of Health (MOH) with support from the World Health Organization (WHO). At the same time, several actors, local and international joined the fight against HIV/AIDS". (2006a). The fight against AIDS resulted in a formulation of Multi-sectoral AIDS Control Approach (MACA) in 1992 and the National Operation Plan in 1993 along with the establishment of Uganda AIDS Commission (UAC). Historical Context "A National Commission on AIDS was created to coordinate educational and medical programs to combat what the government described as a 'scourge.' One in eight children in a population of 18 million have lost one or both parents, either through war or AIDS. Seventeen cases of AIDS were recorded in Uganda in 1983; a decade later the figure was 43,875. The commission has estimated that at the end of 1993, 1,516,000 Ugandans were HIV-positive, and 165,000 actually had AIDS. Within five years these figures were projected to rise to 1,920,000 with HIV and 251,000 with AIDS". (Wall, 1994, p. 707) 1990 1991 1992 1993 1994 1995 1996 1997 Accessed on July 20, 2006 from "Uganda and HIV". Political Context - ABC Approach in Uganda In order to prevent sexual transmission of HIV, the Government initiated ABC operation; the slogan stated "Avoiding AIDS as easy as A bstain, B e faithful and C ondomise". ABC approach was directly associated with Uganda's decline in HIV prevalence as it "increased abstinence, including deferral and considerably reduced levels of sexual activity by youth since the late 1980s; increased faithfulness and partner reduction behaviors; and increased condom use by casual partners". (2006a1) The most vital part, which ABC approach managed to decrease, was the betrayal or partner reduction behaviors by Ugandan men and women. Uganda is considered as one of the most successful country in implementing ABC strategies in different aspects at all levels particularly governmental and nongovernmental, due to which it gained the trust and confidence of millions of Ugandan men and women of all race and classes. Its penetration was so deeply injected in Uganda that besides the urban population, rural people also responded positively towards the movement. After being succeeded in gaining the faith of all age groups it started making recommendations for a safer sex. It was because of these recommendations on individual basis that people didn't mind interfering in their personal matters. "Young persons who had not yet begun to have sex were cautioned to wait, and if a young person had just begun to have sex, then he or she must return to abstinence. If a person was already sexually active, he or she must adopt the practice referred to locally as 'zero grazing' - faithfulness in marriage or partner reduction outside of marriage. For those who continued to engage in risky behavior, condom use was urged to reduce their risk". (2006a1) In September 2002, when USAID hosted a meeting of technical experts from HIV/AIDS programs to consider the evidence regarding ABC behavior change approaches to HIV prevention, it was found that if appropriate planning and management is implemented in some identified areas, there is a possibility to decrease the ratio for which it is spreading. It was decided that all A, B and C interventions would be combined and the blended combination would follow the high-risk population. This area was chosen, as it was much easier to implement and teach the correct use of condom and ways to intercourse as compared to the low-risk populated areas. Political parties, social groups and communities after realizing the extent and significance of A, B, C implementation, actively participated by promoting open communication welfare programs of HIV/AIDS, these programs acted as the main cause of motivating people as to how they can fight with HIV by 'knowing the facts' behind AIDS. Addressing stigma, helped and empowered women and girls to avoid sexual coercion, and developed a multicultural response to enhance the success of ABC behavior changes. Health education messages were mediated through perceptions of risk held by recipients that did not necessarily match those of health educators. Ugandans were simply bombarded with undifferentiated and absolute messages about unsafe sex and risk-taking, which not only affected their behaviour, but also created awareness among them. Different political and social groups undertook number of studies on knowledge, attitudes and practices which assessed their levels of awareness about AIDS, transmission routes of HIV, prevention methods, and attitudes towards people infected with HIV. As an outcome, it became easier for them to make Ugandans realise the haphazard of AIDS. A few looked into behavioural practices that render people at risk. A number of focused information-education-communication (IEC) interventions were also been carried out with different groups. "For the youth, the construction of safer behaviour involved maintaining physical distance from people who were infected, pre-marital abstinence, and sexual intercourse with a condom, monogamous relationship and sex with 'safe' partners however there were a few problems with such constructions of 'safer' behaviour". (Perloff, 2001, p. 24) First, there was widespread ignorance which led to myths about AIDS, e.g., the need felt to maintain physical distance from those infected". Second, their construction of a 'safe' partner was not based on any objective criteria. Safe partners were those who were from 'noble families', 'clean' in appearance and those who were familiar. Risky partners were said to be 'fast' women belonging to an 'open society' such as prostitutes, drug users, urban women and foreigners. "Safer sex in Uganda has been equated with male penetration of the vagina involving condom use". (Perloff, 2001, p. 25) This definition was broadened in the public health discourse and public was given appropriate awareness to believe that sex with condoms constitutes safe sex. However, although such sex is relatively risk-free, it is not 100% without risk because condoms can occasionally break, or may be used incorrectly. "Awareness was created by the social campaigns to teach people the difference between 'safe' and 'unsafe' sex, which referred to sexual activities that greatly reduce the risk of HIV infection, primarily anal or vaginal sex performed with condoms. People needed to be made aware of oral sex as a safer and pleasurable alternative. Sex workers were taught about thigh sex (the man's penis is stimulated between the woman's thighs) and putting condoms on their clients with as part of fellatio. Among some gay men, mutual masturbation and oral sex with condoms were already prevalent but these alternatives need to be propagated widely among others. While mass campaigns regarding the risk of certain sexual acts should continue, the pleasures to be gained from a wider range of sexual acts were easily demonstrated". (Perloff, 2001, p. 25) The association of condoms with AIDS resulted in both positive and negative meanings. The condom user on the one hand was considered healthy, modern and sensible, but also on other hand promiscuous and immoral. For some people, condoms were associated with shame, embarrassment and deviance; they were thus not viewed as an appropriate device for use with one's spouse or long-tem partner. "Representations of condom use needed to enhance their scope so that condoms were not limited to short-term, socially unacceptable, 'casual' relationships. Condoms needed to be associated with eroticism and passion, so that people who considered themselves sensual and passionate viewed them as more acceptable". (Perloff, 2001, p. 26) There has been considerable innovation in the area of AIDS prevention, and these innovations have diffused throughout society. "Although condoms predate the discovery of the HIV, they were taboo topics until social change agents concluded that condoms could help prevent the spread of AIDS". (Stanton, 2004, p. 54) Since the mid-1980s, condoms have become synonymous with HIV prevention. Their popularity has skyrocketed and it has become socially acceptable to talk about them in many public contexts, ranging from university classrooms to entertainment television shows. Although condom usage is sporadic among certain individuals and groups, there is no doubt that millions of individuals worldwide know that condoms help prevent the spread of AIDS and that they should engage in safer sex. Social campaigns were conducted successfully in several cities of Uganda with the help of speeches and in-depth interviews, which were often conducted from HIV-positive speakers. The speakers were recruited during attendance at international AIDS for a via peer support/advocacy groups with an aim to disclose in front of public in order to spread awareness. Getting them to agree to interviews was greatly facilitated by the fact that the interviewers were also living with HIV who does public speaking. This engendered an immediate level of trust in the interviewees and the campaigns turned out to be successful. "Positive people who spoke out publicly were usually highly motivated, either to stop discrimination against HIV-positive people or to prevent further HIV infections and save lives, or both. Many speakers were propelled by a sense of urgency due to which they felt compelled to do this work before they die, which left an influence on Ugandans living in urban and rural areas. As a result many Ugandans interviewees came out in public as a way to educate their communities". (Stanton, 2004, p. 54) Some interviewees spoke out to challenge the attitude that HIV only affects poor, uneducated peasants, or the sexually promiscuous while some expressed the need for people to realise that the elite in society are not invulnerable to HIV. Many possessed the view that people with higher education or of a higher social class think that HIV will not affect them. They did not want to accept HIV and instead ignore its existence. Several speakers spoke of the need for political leaders and government officials to come out as HIV-positive. "People are really dying. Senior civil servants are dying, but nobody comes outEvery senior government official (who dies), they say he has died of a long illness; he has died of diabetes; he has died of heart failure. When a peasant dies they are quick to say he died of AIDS. So, I want to make this clear, to demystify this thing, to let everybody know that the permanent secretary dies of AIDS, the minister dies of AIDS" - Ugandan man (Stanton, 2004, p. 42) The majority of women in the study, including several widows, contracted HIV from their spouses. "Some of these women wanted to warn others of the possibility that they could become infected in any intercourse act such as marriage or prostitution. These women firmly believed that they had a responsibility to educate other women. Although many people in government and non-governmental AIDS organizations in Uganda supported positive activists, many interviewees expressed frustration with the lack of support. Burnout was a real issue for many interviewees, particularly if they were the only ones doing such advocacy work in their area. Some speakers desired training on the practical side of speaking. Others wanted general AIDS education and continual updates on current developments in HIV, so as to be able to answer the many questions that audience members pose. Several interviewees pointed out that it was important to provide positive speakers with information resources because they carried out health promotion and may prevent people from being infected. Some said they have spent years as public educators without being acknowledged for their work, or receiving any training". (Stanton, 2004, p. 43) Whatever remained the circumstances, interpersonal communication in Ugandan AIDS prevention campaigns frequently took the form of street outreach activities, small-group discussions, classroom instruction, and peer counseling which resulted immediately in the frequent decline of AIDS. In the absence of an AIDS vaccination, education has always remained a major weapon in the battle against HIV infection, whether it is in the formal education given in educational institutes or informal conducted through meetings, surveys and public speeches. Yet to educate or, more precisely, persuade people to take precautions against AIDS, an understanding of the dynamics of their safer sex attitudes and behaviors is still needed. "Campaign practitioners cannot influence people unless they understand the mental goblins and cognitive traps that impede people's efforts to change". (Perloff, 2001, p. 24) References 2006a, accessed on July 18, 2006 from < http://hivaidsclearinghouse.unesco.org/ev_en.phpID=5624_201&ID2=DO_TOPIC> 2006b, accessed on July 20, 2006 from 2006a1, < www.aidsuganda.org/pdf/ABCs_of_prevention.pdf> Perloff M. Richard, 2001. "Persuading People to Have Safer Sex: Applications of Social Science to the AIDS Crisis": Lawrence Erlbaum Associates. Place of Publication: Mahwah, NJ. Stanton Theresa, 2004. "HIV/AIDS and Information": ASLIB-IMI. Place of Publication: London. Uganda and HIV, Wall M. James, 1994. "Devils and Plagues: The AIDS Scourge in Uganda" in "The Christian Century". Volume: 111. Issue: 22. The Christian Century Foundation; COPYRIGHT 2002 Read More