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HIV/AIDS prevention in Uganda: why has it worked?
  1. S J Genuis,
  2. S K Genuis
  1. Correspondence to:
 Dr S Genuis
 2935-66 Street, Edmonton, Alberta, Canada, T6K 4C1; sgenuisualberta.ca

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HIV/AIDS prevention

The World Health Organisation’s 2004 report Changing History describes the HIV/AIDS pandemic as “the world’s leading public health challenge” and anticipates catastrophic social and economic consequences in many developing countries.1 This infection, the leading cause of death among 15 to 59 year olds worldwide1 and the second leading cause of serious sickness and disability in the world,2 infects an estimated 14 000 people each day. In noticeable contrast with escalating HIV rates in many nations, a unique programme in Uganda, one of the nations worst hit by the HIV epidemic, has resulted in a profound decline in national HIV seroprevalence from reported rates as high as 30% in the early 1990s3,4—the highest in the world at the time4—to an estimated 5% in 2001.5 Given the proportions of the global HIV/AIDS pandemic, a public health crisis that is only in its early phases,6 many organisations and groups have endeavoured to explicate factors contributing to the national success of Uganda’s strategy.

In the late 1980s, when the sequelae of rising HIV rates were becoming increasingly evident, public health programmes tackling HIV/AIDS were started. The strategy of risk reduction through the promotion of barrier protection became the mainstay of most behavioural interventions. Uganda, however, “went against the current”7 and chose an adaptable strategy that was designed to target all segments of the population through an “ABC” approach to sexual behaviour change: delayed sexual debut for youth (A, abstinence), partner reduction for the sexually active (B, be faithful), and factual information regarding condom use for those who were infected or involved in risky lifestyles (C, condoms).5,8 The recent recognition of the remarkable diminution in HIV/AIDS in Uganda at a time of escalating rates of HIV seroprevalence in neighbouring countries …

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