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The Missing Condoms

Editorial, New York Times, September 4, 2005

Uganda became Africa's leader in fighting AIDS by waging an all-fronts war. In 1991, 15 percent of Uganda's adults were infected with the virus. Ten years later the figure was 5 percent. Ugandan officials achieved this drop by bringing the disease out into the open and encouraging people to protect themselves. President Yoweri Museveni called the fight "a patriotic duty." The government and a network of citizens' groups promoted abstinence, faithfulness and consistent condom use.

Now this balanced approach is tilting, and Ugandans will die as a result. The country still prescribes condoms for high-risk groups. But in the last few years, pushed by Washington, it has begun to emphasize abstinence only, for the general population. Washington is moving away from condom advocacy in all its overseas AIDS programs, but Uganda is the only place that this policy has been so fully embraced by the government. Last year at an international AIDS conference, Mr. Museveni gave a blistering speech attacking condoms. Meanwhile, his wife, Janet, has been condemning condom use as immoral and has called for a national census of virgins.

Billboards that promoted condom use have come down. More than half of Washington's funds for preventing sexual transmission of AIDS now go to groups promoting abstinence only. Among Washington's grantees are groups that argue incorrectly that the AIDS virus can pass right through a condom. While free condoms used to be widely available at clinics in Uganda, in the last year they have virtually disappeared, and condoms in stores have tripled in price.

The most important development of the past year is the disappearance of free condoms. A year ago, Ugandans began to complain that the Engabu brand made in Germany and China and distributed free by Uganda's health system smelled bad. Uganda sent a batch to Sweden for testing and they were found to have holes. Further widespread testing found that the condoms were actually fine, but by that time the government had so attacked the brand that people will not use them. Some 30 million Engabu condoms are sitting in warehouses.

As result only eight million free condoms have been available to Ugandans in the past year, while 80 million were needed. The government has no plan to address the shortage. Instead, it has put a new fee on condoms sold in stores, raising a shortage-inflated price further. And it instituted a requirement that condoms undergo new testing after they are received in Uganda. Extra testing is fine, but Uganda has halted all condom distribution for months while it sets up the testing regime. An emergency supply received in April is still sitting in warehouses.

Promoting abstinence and faithfulness has been crucial to fighting AIDS in Uganda. But so have free condoms. One of the highest-risk groups is young married women infected by straying husbands. For them, abstinence is not an option, and they are already faithful. They need to be able to protect themselves. Abstinence-only teaching does not work in the United States, and there is no reason to think it will work in Uganda.

The policy shift in Uganda threatens to undermine the country's success in bringing AIDS into the open. Ugandans felt relatively free to talk about the risks of catching the AIDS virus and to be open about living with AIDS. If condom users are branded as immoral, it will drive the epidemic back underground. No one knows better than the Ugandans that lives are saved when AIDS is treated as a public health challenge, not a moral crusade.

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