Uganda mulls US role in Aids fight
Why Ugandans hope the Aids fight will be helped, not hindered, by a new US president.
Last Modified: 14 Oct 2008 14:36 GMT

Aids activists in Uganda want US funding to come without conditions

As part of its US election coverage Al Jazeera has been talking to people across the world for their thoughts and perspectives on the presidential race and how it will affect their lives.

Haru Mutasa travelled to Uganda to speak to people about the US government's funding for the fight against HIV/Aids, the controversies surrounding conditions attached to the funding, and what challenges a new US president will face in assisting the fight against the disease in Africa.

In focus

In-depth coverage of the US election
Sharon Weroniso knows she could lose her job for missing work – but right now being at hospital is more important. 

She is 25 years-old and HIV positive. Too poor to afford treatment on a janitor's salary, she needs the free generic drugs she is receiving from the local clinic.

"I had pains on my neck and I had gone find out about the pains on my neck," she says.

"I was advised by the doctor to get tested – then I found out that I was HIV positive."

Kiswa Health Centre is a government-run facility in Kampala, the Ugandan capital, that is largely funded by PEPFAR – the US President's Emergency Fund for Aid Relief. 

Pepfar has allocated $50 billion to the global fund to fight Aids. 

The US government estimates that almost two million people have access to anti-retroviral medications in the five years since the programme was introduced.

But the US insistence that a large part of the funds should be spent on abstinence and fidelity programmes, has been seen as controversial on the continent. 

And although the restrictions have been lifted in the new round of funding, changes on the ground are yet to be felt. 

Controversial conditions

Many question if abstinence works as an anti-Aids strategy [Credit: Sam Rich]
At Kiswa, the money has run out and nurses are worried. They cannot help the 30 new patients they get a day. They are battling to help the 200 patients they already see every day. 

Even though more funds have been approved by the US congress – these people will only get it in 2009. 

But conditions that came with how the money should be used were controversial. 

Organisations had to make abstinence and fidelity programmes a priority. Distribution of condoms – though encouraged - was not given the same amount of attention. 

Solome Nakaweesi Kimbugwe, an Aids activist who works for Akina Mama wa Afrika, a non-governmental organisation working to empower women across Africa, says the abstinence clause is not practical. 

"The emphasis on abstinence and being faithful is not a strategy that works for African women," she says.

"And with practices such as early marriages, bride price, female genital mutilation and some of these values that people hold within African societies, you can't expect African women to deal with HIV and Aids through only abstaining, because fundamentally they do not control their bodies."

And even though some changes have been made as to how the money can be spent, some women - for example commercial sex workers such as Daisy and Macklean - say they are turned away from clinics because of their profession.

"We are the people who are in the system - we are the people having sex everyday," they say.

"We need the condoms - because if we don't have the condoms we shall spread the virus."

Conservative views

Pastor Ssempa argues high condom use
means more Aids cases
Critics of the US initiative suggest one reason why commercial sex workers cannot access funding may be US conservative views on religion and morality.

It is a view some Ugandan leaders support – and this could be why the country is receiving money. 

It is estimated that one million Ugandans are living with the disease – and though infection rates dropped a few years ago – numbers are climbing again. 

Now Ugandans are asking - why the sudden rise in numbers? 

"More and more emphasis was put on drugs and less on prevention," says Dr David Kihumuro Apuuli, director of the General Uganda Aids Commission.

"So you are increasing the numbers [and] you measure your success in terms of how many people you have put on drugs, but you are forgetting that if you do not combat the number of new infections taking place you will never catch up."

But Pastor Martin Ssempa, a local churchman in Kampala, disagrees. He has his own theory on using condoms. 

"Across Africa we have a problem that higher condom numbers do not correspond with lower HIV levels. We actually see the opposite," he says.

"Higher condom use corresponds with higher HIV/Aids [levels]."

He also believes that prostitutes have no place in society – and should not be helped.

Scepticism over change

But poverty forces many women onto the streets, often leading them to engage in risky behaviour. 

Activists want US funding for HIV/Aids to come without conditions – and say that anyone who needs help should be able get it.

And that is why most activists are calling for a multi-pronged approach to fighting HIV/Aids – where the same emphasis should be put on condom use as abstinence and faithfulness. 

Now organisations receiving money do not have to use one-third of their funds on abstinence-only programmes. 

But if they use less that 50 per cent of the money promoting abstinence and faithfulness, they have to explain why. 

And even though US officials say some restrictions have been removed, there are those in Africa who remain sceptical.

Al Jazeera
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