Less They Know, The Better, The

This 80-page report was published in Human Rights Watch, Vol. 17, No. 4 (A).

Excerpts from the summary

“Widely hailed as a leader in the prevention of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), Uganda is redirecting its HIV prevention strategy for young people away from scientifically proven and effective strategies toward ideologically driven programs that focus primarily on promoting sexual abstinence until marriage.


Although endorsed by some powerful religious and political leaders in Uganda, this policy and programmatic shift is nonetheless orchestrated and funded by the United States government. Pioneered in the United States in 1981, “abstinence until marriage” programs (also known as “abstinence only” programs) teach that abstaining from sex until marriage is the only effective method of HIV prevention and that marriage between a man and a woman is the expected standard of human sexual behavior.


Numerous U.S.-funded studies have shown these programs to be ineffective at changing young people’s sexual behaviors and to cause potential harm by discouraging the use of contraception. The effect of Uganda’s new direction in HIV prevention is thus to replace existing, sound public health strategies with unproven and potentially life-threatening messages, impeding the realization of the human right to information, to the highest attainable standard of health, and to life.


Despite a reported dramatic drop in HIV prevalence in Uganda in the 1990s, from an estimated 15 percent nationally in 1992 to 6 percent in 2002, Ugandans of all ages continue to face a high risk of HIV infection. Ugandans tend to start having sex at an early age and with little sex education. Demographic and health surveys show that over half of Ugandan girls have had sex by age seventeen, usually with someone older. Among girls who marry before the age of eighteen, most marry men who have been sexually active for several years, often without having used condoms.

These and other factors make it vitally important to educate young people about HIV and to caution girls at an early age about the risks of HIV infection in marriage. Abstinence-until-marriage programs fail on both of these counts. Not only do they fail to offer young people information about condoms and safer sex on the grounds that this would undermine the goal of abstinence, they additionally promote marriage to young people while withholding information on its inherent risks.


Government officials in both Uganda and the United States routinely characterize Uganda’s HIV prevention strategy as “ABC,” where A stands for abstinence, B for being faithful, and C for condom use. This acronym is designed in part to give the impression that Uganda has always encouraged abstinence as part of its anti-AIDS efforts, and that abstinence contributed significantly to marked declines in HIV prevalence in Uganda in the 1990s. Again, this impression is misleading. Delayed sexual debut was and continues to be one of many messages provided by Ugandan AIDS educators; however, Uganda did not implement abstinence education on a large scale until the United States began promoting these programs internationally around 2001.


Moreover, there is scant evidence that abstinence (as opposed to other behavior changes) contributed significantly to reported declines in HIV prevalence in Uganda in the 1990s. Many veteran AIDS educators in Uganda told Human Rights Watch they had never heard of “ABC” until the United States branded Uganda’s success with this alphabetical sound-bite. While ABC proponents have been able to uncover elements of Uganda’s AIDS strategy that support the ABC model, the definition of ABC in the 2003 U.S. global AIDS strategy—Abstinence for youth, Be faithful for married couples, and Condoms only for “high risk” populations—is a uniquely American invention.


At this writing, an estimated 6 percent of the adult population in Uganda is infected with HIV, significantly less than the estimated 15 percent national prevalence a decade ago. Uganda has been rightly praised for this achievement. However, the country still faces a generalized HIV/AIDS epidemic and cannot afford to attack proven HIV prevention strategies and adopt discredited ones. Uganda is home to nearly 1 million children orphaned by HIV/AIDS, many of them at high risk of HIV infection themselves. Efforts to expand access to antiretroviral treatment for people living with HIV/AIDS still have a long way to go, making it especially important to sustain effective and widespread HIV prevention measures. As an acknowledged leader in HIV prevention, Uganda should be building on its success, not adopting the United States’ failures.”