In chronically poor Uganda, HIV prevalence and rates of new infection appear to be stable or in decline. Botswana, relatively prosperous by comparison, has failed to control the pandemic and now has a lower life expectancy at birth than Uganda. What does this mean for HIV/AIDS policies in Africa?

In the late 1980s, Uganda was widely viewed as the worst HIV/AIDS-affected country in the world. It remains a very poor country with extremely limited public health and education systems and high levels of illiteracy. However, there has been a decline in both incidence and prevalence at several rural locations and it is now accepted that Uganda has been spared the explosive growth rates of the epidemic experienced in southern Africa.

Unlike Uganda, Botswana has an effective public health service, ethnic cohesion and a highly literate population. It has also enjoyed decades of stable government and economic growth. HIV/AIDS policies, however, have not had the expected results. Life expectancy at birth for 2002 stands at 38, compared to 43 for Uganda.

A report from the London School of Economics and Brunel University in the UK describes how both Uganda and Botswana were quick to respond when AIDS was discovered in their countries. Botswana launched highly-publicised and westernised campaigns but by the mid-1990s these were receiving less attention, including from donors. In Uganda, diverse groups including President Museveni, church groups and local councils were involved in promoting sexually responsible behaviour. Museveni has also ensured that Uganda has probably never had to fund more than a tenth of its HIV/AIDS awareness and treatment programme.

The authors describe how:

• The Botswana Government acted even before the effects of HIV/AIDS were noticed by the public, who were therefore sceptical of its existence; in Uganda, people were aware of AIDS before the government launched its programmes.
• In Botswana, many people believed those who depicted AIDS as divine punishment for immorality; such ideas were not widely accepted across the ethnic divisions of Uganda.
• Botswana’s use of an exclusively western information model led to suggestions that the use of condoms was itself dangerous; Uganda successfully adopted a family values model which avoided promoting condoms.
• Botswana’s economic growth – powered by the diamond, cattle and tourism industries, which employ relatively few people – is not seriously threatened by the epidemic; agriculture-based Uganda has had strong economic incentives to reduce AIDS mortality.
• Botswana has attempted to lead Africa in the provision of mass access antiretroviral treatment for AIDS, but is facing difficulties due to the extreme reluctance of Botswanans to come forward for testing.
• Botswana’s variety of overlapping programmes is poorly coordinated and confusing.

Divergent outcomes in the two countries suggest that:

• When treated with respect, groups excluded in one country (such as traditional healers and churches in Botswana) can become active agents against HIV/AIDS elsewhere.
• Linking human rights concerns to HIV/AIDS, as Botswana has done with its stress on confidentiality, persuasion and gentle encouragement, hinders public health measures.
• Testing should become the norm rather than a choice for the public.

Human behaviour rarely changes because of health education alone. Human error has allowed the HIV/AIDS pandemic to become a public health disaster. Tough responses are now needed to bring it under control.

Source(s):
‘HIV/AIDS policy in Africa: what has worked in Uganda and what has failed in Botswana?’ by Tim Allen and Suzette Heald, Journal of International Development 16, pp 1141-1154, 2004

id21 Research Highlight: 5 May 2005

Further Information:
Tim Allen
Development Studies Institute (DESTIN)
London School of Economics
Houghton Street
London WC2 2AE
UK

Tel: +44 (0) 2079556430
Fax: +44 (0) 2079556844
Contact the contributor: t.allen@lse.ac.uk

Development Studies Institute (DESTIN), London School of Economics, UK

Suzette Heald
School of Social Science & Law
Brunel University
Uxbridge
Middlesex UB8 3PH
UK
Brunel University

Tel: +44 (0) 1895274000
Fax: +44 (0)1895203018
Contact the contributor: suzette.heald@brunel.ac.uk

Brunel University, UK

Other related links:
'Cracking down on the HIV/AIDS crisis: can global targets work?'

'The impact of HIV/AIDS on rural livelihoods'

'Why AIDS is a workplace issue'

'Where have all the babies gone? HIV and fertility in Uganda'

'University challenge – the impact of HIV on higher education in Botswana'

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