Rural Uganda making sense of HIV/AIDS

1989: Rakai District, Uganda. Gwanda is a small isolated village, a beautiful place close to Tanzania near Lake Victoria but with a sad reputation. It is situated in the epicentre of the AIDS epidemic and of the war, when the Tanzanian troops came to overthrow Idi Amin.

People created their own local responses to the AIDS epidemic - probably just as effective as the short-term programmes and medium-term programmes being implemented from Geneva, via Kampala.

Mr Julius, a local village leader asks: 'Why are you asking questions about agriculture? Don't you know about AIDS - it is killing many people.' He explains that the local community had decided to ban discos! By stopping teenagers from dancing together at weekends and confiscating sound equipment - through a very intrusive local bye-law - Julius and the other elders had made their own intervention. Since then, many other similar local interventions have contributed to reducing transmission rates and prevalence in Uganda.

2005: Gwanda is now very different: four hours from Kampala, good road and mobile phones. The chairman of the Parish Council, Mr Samuel, aged 30, explains how he became an AIDS orphan when he was seven, in 1982. He and his older sibling raised themselves and the younger ones. He pointed to the school and said, 'Ninety percent of the children there are AIDS orphans'.

Mr Samuel, now, feels responsible for preventing the spread of HIV but how can he do this? Pointing to the lakeside settlement he says: 'I go down there regularly. When I see a girl from this village working as a 'barmaid' or a young boy working as a fisherman, I beat them back to school!' He cracked the knuckles of his right hand for emphasis, the sharp snap leaving no doubt that physical force would be used if he thought it appropriate.

Uganda's prevalence level fell to around 5 percent from 20 percent in the late 1980s. Local public health responses such as those described above have been an effective part of Uganda's achievement. We need to think about this in relation to both 'one-size-fits-all' such as 'Abstain, Be faithful, Condomise', and generalised human rights based approaches. Pragmatic heterogeneity, not ideology, is the key to good public health strategy!

Tony Barnett
Development Studies Institute, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
T +44 (0)207 8523722
F +44 (0)207 9556235
a.s.barnett@lse.ac.uk

This article is based on field-visit notes from Uganda over the past 20 years

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