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Friday, July 11, 2003 - Page updated at 12:00 AM

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Uganda's war on AIDS: Candor more crucial than abstinence, officials say

The Washington Post

• In a decade that saw the disease ravage Africa, Uganda has reduced its infection rate from 30 percent to 5 percent. Condom use and early sex education are heavily promoted. The Bush administration, on the other hand, has directed much of AIDS prevention money for Africa to groups stressing 'abstinence-only before marriage' messages. So when President Bush visits today, he will likely be pressed to reconsider his views.

ENTEBBE, Uganda — Scrambling around the room wearing a puffy strawberry- and cream-colored dress, 7-year-old Florence Nampiuja plops into a seat, swings her thin legs beneath her and explains how to protect against unsafe sex. She uses her tiny hands to show how to use a condom. She hums a song about how to stop "sugar daddies" from persuading women to have sex.

Such candid talk may seem astounding, but it's no wonder Florence is learning about safe sex at a tender age. She's sitting in the single-story, concrete building of The AIDS Support Organization, or TASO, holding her aunt's weak hand, cheering up yet another woman in her life who is dying from the disease.

Florence knows how AIDS is transmitted because Uganda has waged a successful fight to reduce its infection rate by enlisting the entire population in a frank discussion about sex. Condom use is heavily promoted, putting the Ugandans at odds with the Bush administration, which pushes abstinence and has directed about one-third of new AIDS prevention money for Africa to groups that advocate "abstinence-only before marriage" messages.

So when President Bush visits this clinic in the lush hills near Entebbe's airport today during his five-day trip to five African nations, he is likely to hear some opinions contrary to his own.

"It's too idealistic to say abstain when I serve 50,000 people for AIDS alone in my clinic," said Michael Bernard Etukoit, the manager of TASO.

In Uganda, where nearly 1 million people have died as a result of AIDS since it was first identified in the East African nation in 1983, it's almost never too early to start talking about AIDS or sex education. The entire country, from the president to grandmothers and first-graders, has mobilized over the past 11 years in Africa's most successful fight against the epidemic. While Africa is home to 70 percent of the world's HIV patients, and in some countries at least one in three adults are HIV-positive, Uganda's AIDS and HIV infection rates have plummeted from 30 percent to 5 percent in slightly more than a decade.

Uganda's HIV-fighting mantra is referred to as ABC: Abstain, be faithful or use a condom. The government launched a massive campaign on radio, television and in newspapers to encourage people to get tested and to follow the ABC's. It was the first African country to even talk about AIDS, which had been considered a taboo topic. In Kenya, leaders denied AIDS existed and called it "a mysterious disease."

Still, the rates of infection in Uganda are uneven, with higher numbers in rural areas where free testing is less available and people cannot afford the $4 to $7 fee, health workers say. Rural residents also don't have as much access to condoms and health care. Women living in poverty suffer the most because they perform sex for money. But in the cities, people of all ages are frank and focused about wearing condoms and getting tested frequently.

"I think it's very good that she knows everything," said Florence's aunt, Zeporah Mukamusoni, who came to TASO to receive medicine and counseling. She was doubled over, had a swollen back and, she said, a pounding headache. "This is our life here. We can't fight it if we are hiding. I would die happy if I knew she understood."

Florence's mother died last year after suffering from a violent cough and nighttime fevers that Florence treated by placing a warm rag on her head. Florence doesn't know who her father is.

Health-care workers here say they hope that as Bush witnesses the poverty that often forces women and young people into sex and sees the epidemic's heartbreaking damage, he will consider alternatives to abstinence alone.

Bush, who has said the world is morally obligated to help save lives, has pledged $15 billion for programs to prevent and treat AIDS in sub-Saharan Africa and the Caribbean.

Edith Mukisa, the feisty project manager at the Naguru Teenage Information and Health Center in Kampala, Uganda's capital, was concerned about the emphasis on abstinence and thought she might not qualify for some of the money.

"It's a big problem, this abstinence stuff," she said. "Look, it's OK to use a condom if you are having sex. And by the way, it's OK to talk to your children about it. If you know that child might get AIDS and suffer, who cares if a 10-year-old knows what a condom is? I want to tell Bush I just don't get the problem" with educating the population on various methods of AIDS prevention.

Young people pick up condoms and watch videos on both abstinence and safe sex at her center. A pamphlet at the center titled "Hot 'n' Healthy" shows a sketch of a couple with their hands down each other's pants.

Uganda is trying to make virginity trendy with the younger generations by saying it's OK, even healthy, to wait to have sex until marriage, but officials are unsure how that message is going over. They stress, however, that condoms work and often cite health-care studies and their own negative HIV tests to prove it.

Condoms are stocked in the restrooms of popular restaurants and bars every night. In the lusty personal ads published every Friday in the popular weekend tabloid, the Red Pepper, a person's HIV-negative status and acceptance of condom use are advertised along with looks, height and job status.

The Straight Talk Foundation, a 10-year-old nongovernmental group that is one of the country's most successful promoters of fighting AIDS, produces colorful newspapers and radio shows for Africa's next generation. The group discusses everything from masturbation to myths about virginity and the effects of poverty on sex.

One of the common questions the foundation gets from women is what to do if men offer them money or gifts to have sex without a condom. They also tell of men who say girls will grow a bone in their vaginas if they don't have sex before they are 15, and of men who use money to entice girls into having sex by offering to pay their school fees.

"If we must tackle HIV, then we must tackle all of the issues. Uganda realizes that we have a problem with AIDS, so let's deal with it," said Sanyu Nkiinzi, a radio announcer for Straight Talk.

At the Nakasero Primary School in Kampala, sex education is taught to children every day starting in the third grade. A room in the school is set aside for the counseling of girls. Posters warn of "sugar daddies" wanting sex and why to avoid sharing a bed with a male relative.

Winnie Nyongore, 12, recounted how a man she knew started harassing her and telling her he would take her out to a popular fast-food chicken restaurant and to other fun places if she slept with him and he didn't have to use a condom. She knew to say no, with or without a condom, and whom to report him to.

"I want a bright future," she said. "I'm glad I knew about these things."

At TASO recently, Bush's security team wandered around the site, talking into cellphones. Nearby, a drama group of HIV-positive community leaders — who call themselves the HIV Positive People — practiced a song they would sing for the president.

Joyce Nakabyebu, 33, who is HIV-positive and suffering from spinal tuberculosis, sang with a thin and sweetly melodic voice that filled the quiet area.

"Why you? Why me? Why him? Why her? We are wondering why this came to us. We did not get a chance of knowing what AIDS was all about," she sang. "Now, despite being rejected by our families, we have a lot to say. AIDS has no mercy for people who think they know better."

Copyright © 2003 The Seattle Times Company

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