Statement Of Sen. Alexander - Fighting AIDS In Uganda: What Went Right?

Posted on April 13, 2005

In the midst of the AIDS pandemic, a beacon of hope shines out from Uganda. The rate of infection has declined from about 15 percent in 1991 to about 5 percent in 2001. Uganda did this largely through a nationwide campaign focused on the "ABC" model: Abstain, Be faithful, use a Condom. Today, we will look at how that model works in practice and what that implies for U.S. policy in combating AIDS. The worldwide crisis posed by the AIDS pandemic is growing worse everyday. Over 40 million people are now infected by HIV/AIDS. Thirty million of those are in sub-Saharan Africa — nearly 5 percent of the overall population. The scope of the problem is overwhelming. Eleven million African children have lost their parents to AIDS. In Zambia, 30 percent of all children are AIDS orphans. In Botswana, nearly 40 percent of the adult population is HIV-positive. The disease also affects other sectors of African society. Seven million agricultural workers have succumbed to AIDS. The agricultural workforce has been depleted by more than 20 percent in several African countries, resulting in production declines that are a contributing factor to hunger and even famine. Young adults are the hardest hit by the virus, leaving not only millions of orphans, but also ever-increasing numbers of households headed by grandparents. But in the midst of this human tragedy, there is a glimmer of hope. Something different is happening in Uganda. Despite the lack of a cure or vaccine, HIV infection rates are declining. For example, in 1991 21 percent of pregnant women in Uganda were HIV-positive; ten years later that number had declined to 6 percent. (By comparison, 43 percent of pregnant women in Botswana were HIV-positive in 2000.) What is Uganda doing differently? Led by President Museveni, Ugandan society has mobilized to combat HIV/AIDS with vigor. Uganda has taken a comprehensive approach to combating the challenge. Religious and military leaders, some of whom are HIV-positive themselves, have led the way in creating an open dialogue that has to a large extent de-stigmatized the disease. With the help of groups like The AIDS Support Organization of Uganda, the country has sought to provide treatment and care to those infected. But the heart of the Ugandan story is behavior change, promoted by the "ABC" model — Abstain, Be faithful, use a Condom. The campaign has had great success. In one area of the country, for example, 60 percent of youth aged 13-16 reported being sexually active in 1994; by 2001 the number had fallen to 5 percent. Similarly, the number of Ugandan men with two or more sexual partners per year dropped from over 70 percent in 1989 to less than 20 percent in 1995. So how does the Uganda model work in practice? How can that model be replicated or adjusted to work in other countries and cultures? What does that imply for U.S. policy and foreign assistance in combating this pandemic around the world? That's what we're here to find out, and we have a distinguished panel to help us do that this afternoon. I also hope to explore with the witnesses the idea of having an AIDS Corps — where American health professionals could volunteer to go to African or other hard-hit countries and help train professionals in-country how to provide care and treatment for those infected and affected by HIV/AIDS. I introduced a bill for that purpose last week.