Condom crisis persists in Uganda

By Henry Neondo

A campaign against condoms, onstensibly spearheaded by the Uganda's First Lady, Mrs Janet Museveni has Uganda in serious condom crisis, which is now in its 10th month.

But accordig to the US-based Center for Health and Gender Equity (CHANGE), the crisis could soon spread to cover Kenya, Namibia, and Tanzania where U.S. funding is indirectly supporting the resurgence of fundamentalist religious movements and undermining effective HIV prevention.

In Nigeria, for example, CHANGE says, that 80 per cent of President Bush’s Emergency Plan for AIDS Relief (PEPFAR) funding for prevention of sexual transmission is being spent on abstinence/be faithful programs and large amounts of PEPFAR funds are flowing to "faith-based" groups with no proven track record in public health.

In the words of Dr. Richard Tiemoko, an expert on reproductive and sexual health issues in Nigeria, "Pentecostal and evangelical Christians are certainly gaining importance in Nigeria.

One has the impression that both U.S. Policy and these emerging religious and cultural fundamentalisms are reinforcing each other to support abstinence only programs.

" Similar trends are underway in a number of other countries, including Zambia, where reduced supplies of condoms, and shifts in funding of prevention programs is leaving millions at risk, and
Recently, U.S. funding for a successful outreach program to sex workers run by Population Services International in Central America was cut based solely on ideological concerns, and condom social marketing programs have been removed from new PEPFAR guidelines for prevention in Central America and Mexico.

According to CHANGE, condoms have of late become difficult to find in Ugandan cities, even for a price, and are unavailable in many rural areas.

Field reports indicate that in some areas, including those with large numbers of internally displaced persons, people desperate to prevent HIV infection have begun using garbage bags as condom substitutes.

Similar condoms shortages and abstinence-only campaigns -- including those funded by the Bush Administration -- are reducing access to and undermining public confidence in condoms as a tool for prevention of both HIV and unintended pregnancy in other countries as well.

"The crisis in Uganda has been created by the actions -- and inaction -- of the Government of Uganda and the Bush Administration, the primary donor for HIV/AIDS programs in Uganda, and a major force in undermining effective HIV prevention programs throughout sub-Saharan Africa and Central America," stated Jodi Jacobson, Executive Director of CHANGE.

The United States contributed $137 million dollars to Uganda for HIV prevention and treatment programs under PEPFAR in 2005, and will contribute over $170 million in 2006.

The two largest sources of condom supplies in country are the Ugandan government and the U.S. government.

Since the mid-nineties, the Government of Uganda has provided condoms free through government health clinics under the brand name Engabu.

Condoms provided by the United States have long been sold in Uganda through social marketing programs at subsidized prices.
These were further supplemented by smaller stocks from other donors.

In October 2004, the Museveni government issued a nationwide recall of Engabu based on disputed claims that the condoms were of poor quality.

Condom supplies were further reduced when the government began requiring that all condoms entering the country, including those from the United States, undergo quality testing after delivery in Uganda, even in cases where pre-shipment quality tests had been performed.

All condom stocks in government warehouses were impounded and further shipments of Engabu under the contract held with a German-Chinese consortium were rendered worthless.
"The government took this drastic step with no back-up plan in place," stated Jacobson, "resulting in a major crisis in the country."
And, to make matters worse, she continued, "new taxes and campaigns to discredit condoms have further reduced access to condoms, and undermined public confidence in prevention technologies overall after years of successful efforts to promote safer sex."

"According to the Ugandan Ministry of Health," notes Jacobson, "an estimated 120 million to 150 million condoms are needed per year to meet the basic need for HIV prevention in the country. "

In a "good" year, according to the MOH, actual supplies would be 120 million condoms. But the past two years have seen rapidly diminishing supplies of and capacity for distributing condoms.

Due to shifts in prevention funding under PEPFAR, those at greatest risk are being denied the information and technologies necessary to prevent infection.
"For example," noted Jacobson, "adolescents and young adults ages 15 to 24 are at high risk of infection in Uganda, but are no longer included in outreach campaigns intended to promote safer sex."

In Uganda, the average age at first intercourse for females is 16.7 years, while the average age at first marriage is 17.8 years of age, a gap of over a year.

Sixty-six (66) percent of all males and females ages 15 to 24 (married and unmarried) are sexually active.

Yet with support and pressure from the United States, people in these age groups are no longer eligible for comprehensive prevention programs, and instead are targeted only by abstinence programs.

In 2005, approximately $20 million dollars of PEPFAR funding went to prevention programs in the country.

Of total prevention funds for Uganda under PEPFAR, 76 percent were spent on prevention of sexual transmission, and 56 percent of all funds for prevention of sexual transmission were spent on abstinence-only programs.

The other 44 percent of funds for prevention of sexual transmission is highly restricted, according to sources in the field, and may only be used for outreach to sex workers, truck drivers, and people in bars.

Billboards supporting multiple approaches-abstain, be faithful, use condoms-have been replaced by those focusing only on abstinence.
These same trends are evident in many countries receiving PEPFAR funding, notes Jacobson.