U.N. Special Envoy Says U.S. Funding Cuts for Condoms, Abstinence-Only Prevention Promotion Led to Alleged Uganda Condom Shortage
U.N. Special Envoy for HIV/AIDS in Africa Stephen Lewis and other AIDS advocates on Monday said the Bush administration's policy of promoting abstinence prevention programs and cuts in federal funding for condoms have contributed to an alleged condom shortage in Uganda and undermined the country's HIV/AIDS fight, London's Guardian reports (Vasagar/Borger, Guardian, 8/30). Lewis said in a teleconference sponsored by health and human rights groups that "there is no question that the condom crisis in Uganda is being driven and exacerbated by [the President's Emergency Plan for AIDS Relief] and by the extreme policies the administration in the United States is now pursuing" (Altman, New York Times, 8/30). He added, "To impose a dogma-driven policy that is fundamentally flawed is doing damage to Africa" (Tomlinson, AP/USA Today, 8/29). Jodi Jacobson -- executive director of the U.S.-based Center for Health and Gender Equity, also known as CHANGE -- said, "[T]here has been a dangerous and profound shift in U.S. donor policy from comprehensive prevention, education and provision of condoms to focus on abstinence only" (New York Times, 8/30). Although Uganda's national HIV/AIDS prevention program is considered a model for other African nations, the Ugandan and U.S. governments over the past couple of years have placed an increasing interest in promoting abstinence and fidelity in marriage, with condoms being distributed only to people who cannot manage either prevention tactic, the Guardian reports (Boseley, Guardian, 8/29). The Ugandan government provides condoms primarily to commercial sex workers and truck drivers, two populations considered to be the most at-risk of HIV infection (New York Times, 8/30).
U.S. Government Response
Deputy U.S. Global AIDS Coordinator Mark Dybul said Lewis' claims about the U.S. were "completely untrue and completely mischaracterize effective prevention programs" (BBC News, 8/30). Dybul said the AIDS program in Uganda focuses on the "ABC" HIV prevention method -- which stands for abstinence, be faithful and use condoms. "In a concentrated epidemic, in which HIV is concentrated among high-risk groups, condoms are effective. But a condoms-only approach is ineffective in a general epidemic like that in Uganda," he said, adding, "You need to deal with other issues as well" (AP/USA Today, 8/29).
Uganda needs between 120 million and 150 million condoms annually, but since October 2004 only 32 million have been distributed in the country, according to CHANGE (Guardian, 8/30). AIDS advocates on the teleconference said condoms are scarce in Ugandan cities and unavailable in many rural areas, and some men have been using garbage bags as condoms (New York Times, 8/30). New York-based Human Rights Watch in March warned that Uganda's AIDS prevention efforts were under pressure from the U.S. to focus on abstinence and back off condom promotion, AFP/Todayonline.com reports (AFP/Todayonline.com, 8/29). The alleged shortage began in October 2004 when Ugandan President Yoweri Museveni ordered a nationwide recall of condoms that were distributed at no cost in government health clinics under the brand name Engabu, saying they were of poor quality. The government tested the condoms and impounded all of them. Negative stories in the press and comments by Ugandan first lady Janet Museveni drove down public confidence in condoms and new taxes raised their prices. According to the government, the original Engabu condoms are too mistrusted to be distributed, despite testing that determined the condoms are of good quality (Guardian, 8/29).
Ugandan Government Says 'No Shortage'
Mike Mukula, the state minister of health in the Ugandan Ministry of Health, said, "We have enough condoms," adding, "That there is a condom shortage in the country is just a rumor by people who want to spoil the image of this country" (AFP/Todayonline.com, 8/29). He added, "The weight of the ABC is all equal in that abstinence has been one of the critical strengths of Uganda's ability to reduce the prevalence [of HIV] in the country" (BBC News, 8/30). Mukula said that condom distribution in the country continues, with 65 million condoms procured about two months ago and an additional 80 million coming soon (BBC News, 8/29). The Ugandan government has obtained an emergency grant from the U.K. Department for International Development to purchase 20 million new, generic condoms (Guardian, 8/29). In addition, Dybul said the U.S. has helped the country purchase 15 million to 20 million condoms that are in a Ugandan warehouse waiting to be tested (New York Times, 8/30). The California-based AIDS Healthcare Foundation also has pledged to donate one million condoms to Uganda (AP/San Jose Mercury News, 8/30). "Supply chain management continues to be a major obstacle in global anti-AIDS efforts and must be addressed quickly if we are to truly get a handle on this pandemic," AHF President Michael Weinstein said (AHF release, 8/29). Mukula said that if there were a condom shortage, it would be the World Health Organization's responsibility to raise an alert. He also said he will begin touring camps for internally displaced people next week, and he urged those claiming that people were using garbage bags as condoms to accompany him and prove their claims (Lirri, Monitor, 8/29).