Campaigns promoting safe sex is are being used to prevent the spread of AIDS in countries where the disease has been prevalent for many years.  However, the effectiveness of such campaigns alone or in tandem with sexually transmitted diseases treatment programmes remains to be fully assessed. In rural Uganda, research shows that so far both methods have had little impact in reducing the numbers of HIV-infected patients. New approaches must be developed to fight AIDS in areas where the epidemic has been raging for many years.

The Medical Research Council, together with the London School of Hygiene and Tropical Medicine, considered whether safe sex campaigns alone, or in combination with effective treatment of sexually transmitted diseases, were successful in fighting the AIDS epidemic in rural Uganda. 18 communities were chosen at random from the Masaka district of south-western Uganda.  They were matched in terms of distance from the district capital, type of road that passed through their communities and quality of the local health clinic. 

The 18 communities were offered a variety of different preventative methods:

• Six of the communities received information and education about HIV/AIDS.
• Six in addition to HIV/AIDS information were provided with access to improved services for the treatment of sexually transmitted diseases.
• The final six, acting as the control group, continued to receive their basic community services. 
• Condoms were put on sale and HIV testing was offered to all three groups.

During the course of the study, which took place between 1994 and 2000, the participants were interviewed and the researchers found that:

• the communities provided with HIV/AIDS information began to use condoms more in casual sexual encounters
• the numbers of patients with syphilis, gonorrhoea and herpes declined
• the number of people who admitted to having two or more sexual partners in the past year did not change
• 15 remained the average age at which young people had their first sexual encounter

It is always difficult to assess the affect of campaigns promoting safe sex as people may give what they believe to be the ‘correct’ answer rather than tell the truth. 30 percent of people in this study who claimed to have used a condom, at second interview admitted that was not the case.  The treatment of sexually transmitted diseases and AIDS information had little impact on the numbers of HIV patients in rural Uganda. Their numbers were already falling as people were made aware of the dangers of AIDS from the tragic experience of the virus amongst friends and relatives. Beyond this, the success of government health campaigns has meant more people are practising safer sex with partners.

The limited changes in sexual behaviour in this study suggest that it remains important to promote and provide treatment for sexually transmitted diseases as these diseases. The methods used in this study may be effective in other regions where HIV levels are rising and less health education is available, such as Mbeya in Tanzania. In regions where the epidemic continues to grow new methods need to be developed to fight the AIDS virus that focus in particular on groups most at risk.

Source(s):
‘Syndromic management of sexually-transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial’, The Lancet 361: 645-652, by A. Kamali et al, 2003  Full document.

Funded by: Medical Research Council, UK; UK Department for International Development; UNAIDS

id21 Research Highlight: 11 January 2005

Further Information:
Anatoli Kamali
Medical Research Council Programme on AIDS
Uganda Virus Research Institute
PO Box 49
Entebbe
Uganda 

Contact the contributor: anatol.kamali@mrcuganda.mimcom.net

Medical Research Council, UK

London School of Hygiene and Tropical Medicine, UK

Other related links:
'Changing behaviour, changing disease – the case of HIV in rural Uganda'

'Fighting HIV/AIDS with awareness: the case of rural Uganda'

'Good news at last – HIV rates fall in Uganda'

'Curbing mother to child transmission: testing pregnant women for HIV'

'Knowledge gap - what do Ugandan schoolchildren know about condoms?'

See id21's collection of links relevant to HIV/AIDS.