Today's young Africans might have a world without AIDS, but nothing is guaranteed. Just ask Uganda

Rwanda has recorded a dramatic 78% drop in AIDS-related deaths, while early star Uganda has retrogressed badly in recent years.

WEDNESDAY was Youth Day, and this month marks eighteen years since Nigerian music legend, activist and all round troublemaker Fela Anikulapo Kuti died of AIDS-related complications.

He was one of the many prominent Africans to die of AIDS. In 1989, celebrated Ugandan musician Philly Lutaaya was the first public figure in Africa to announce he had AIDS. Soon after receiving the news of his status, he embarked on a nationwide tour of Uganda to “give a human face” to the disease, even as he grew increasingly frail.

His move to go public – and the airing of documentary “Born in Africa”, that chronicled the last months of his life before he died in December 1989 – probably did more to start reducing the stigma and change attitudes towards the disease than any official campaign ever could.

For the generation of young Africans born in the 1980s and 1990s, AIDS has always been a part of life – tragic and brutal, yes, but also ubiquitous, and somehow unsurprising.

In the latest UNAIDS report, South African Hollywood actress Charlize Theron, who heads the AIDS philanthropy organisation the Charlize Theron Africa Outreach Project says, “I can’t remember a time when AIDS wasn’t a presence in my life. As a South African, I saw its impact all around – neighbours were sick, communities were scared, and people struggled to get drugs for treatment.”

Without a sense of what the world was like before AIDS, it’s difficult to fully grasp the scale of how much the pandemic shattered families and communities.

By the time Fela died in 1997, prevalence of the disease in sub-Saharan Africa was in the region of 6.1% - but as high as 30% in Botswana, 29.3% in Zimbabwe and 26.6% in Swaziland.

The region was counting 2.2 million new infections a year, and 20 million people were living with the disease. That’s the equivalent of the entire population of Cameroon today.

But the gains made in the last fifteen years has truly been remarkable, since the Millennium Development Goals (MDGs) made reversing the spread of HIV AIDS one of its key goals.

Sharp decline in Rwanda

This week, Rwanda announced a sharp decline in the number of AIDS-related deaths in the past ten years, according to the latest report released by the Rwanda ministry of health.

The country recorded a dramatic 78% drop in AIDS-related deaths in the past ten years, and HIV prevalence is now at 3%, from 5.3% in 2000.

Botswana, with the highest prevalence in the world, has nevertheless seen its overall prevalence drop from 30% to 25%, new infections have more than halved, from 30,000 to 14,000 and AIDS related deaths have plummeted 68% from 16,000 fifteen years ago, to 5,100 today.

Overall, sub-Sahara Africa has seen a 39% drop in new infections, antiretroviral therapy has averted 4.8 million deaths in the region, and mother-to-child transmission has been halved.

In July this year, UN Secretary-General Ban Ki-moon said the world was headed for a “generation free of AIDS” by 2030, sentiments echoed by Michel Sidibé, executive director of UNAIDS.

Threat of extinction

A HIV-free generation was virtually unimaginable just fifteen years ago, when attendees at an international Aids conference in Durban, South Africa, were stunned to hear then president of Botswana famously say, “We are threatened with extinction. People are dying in chillingly high numbers. It is a crisis of the first magnitude.”

A sign at a school in Simonga, Zambia. (Photo/Flickr/John Rawlingson).

But the big gains all around the continent make Uganda’s story today so depressing.

The country was widely hailed for being one of the first countries in Africa to face the disease head-on, recording a dramatic decline in prevalence from 15% in 1992 to an estimated 7.4% in 2000.

But today, Uganda is one of the few countries in Africa that is recording an increase in new infections, both in absolute and relative terms.

In 2000, there were 70,000 new infections a year, today, that’s up to 100,000 – higher estimates put it at 130,000 every year.

Though prevalence has held at around 7.4% over the past ten years, it represents an increase in real terms from 960,000 to 1.5million, as population increases too.

Health experts have blamed Uganda’s retrogression in the fight against HIVAIDS on the government for becoming complacent since winning international acclaim.

Attack on condoms

But also, there was a shift in 2003 in the official policy that promoted abstinence and monogamy, and downplayed condoms as a prevention measure, arguing that promoting condoms alongside abstinence messages would be “confusing” to the public.

The abstinence-only message was most prominently espoused by First Lady Janet Museveni, whose close links with the US evangelical movement ensured that, especially, US donor money would only go to organisations that would promote abstinence and faithfulness in marriage.

The founding principles of leading donor organisation Pepfar – chaired by then US president George W. Bush who had strong support among evangelicals - barred partnering with organisations that did not condemn prostitution, and called for 33% of financing to be spent on abstinence and fidelity programmes.

Condoms were to be promoted only “for those at most risk”, such as sex workers and discordant couples, and the message in Ugandan schools was that pre-marital sex was “a form of deviance or misconduct”.

But the strategy seems to have backfired badly, only succeeding in driving certain behaviours underground.

The Uganda AIDS Indicator Survey published in 2012 found that 90% of Ugandans acknowledged sexual fidelity in a relationship as a health imperative, but roughly 25% of married men said they had multiple sexual partners.

It also found that three-quarters of Ugandans knew that condoms prevented the spread of HIV, but that fewer than 8% of married men who were having sex outside their marriage were using condoms.

More importantly, the implication behind abstinence-only programs that AIDS is a “moral” disease stemming from “promiscuous” behavior is the antithesis of Uganda’s effort to de-stigmatise AIDS early in the pandemic, says this report by Human Rights Watch. Lutaaya would be appalled.

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