Part 2: HIV Prevention Programs before the introduction ehealth in Zambia and Uganda
Ehealth provides innovative solutions to tackle increasingly complex health issues while offering creative solutions in HIV prevention within resource poor countries. Before ehealth initiatives were introduced in Uganda and Zambia preventative strategies were based within national policies advocating for behavioral change. Uganda has a compelling success story of a reduction in HIV/AIDS while Zambia has seen minimal reductions in HIV.
In Uganda HIV peaked around 15% in 1991 and fell to 4% in 2003 (Cohen, 2003; Green, Halperin, Nantulya, & Hogle, 2006). Uganda’s success can be attributed to a combination of government support and behavioral changes through the abstence, being faithful and condoms (ABC) apporch although there is some sceptisium about how much trust can be put in behvaioral changes as a significant factor in HIV declines as some reaserch suggest that the decline in HIV within Uganda is is sue to so many people being defeated by the virus that dealth outweighted the rate of new infections. However the decline in prevelnce rates among younge popultions under 20 cannot be explained by deaths as few in this age group have died from the virus (Green, Halperin, Nantulya, & Hogle, 2006).
In 1986 Uganda’s National response included President Yoweri Museveni recognizing and responding to Ugandans and emphaziging the importantance of fighting AIDS for Uganda. Immeditily Musenveni put HIV/AIDS on the development agenda while acknoledgeing the important of good communication and strong ledership from the village to state house. In 1986 Uganda established a National AIDS Control Program (ACP) and the national sentinel surveillance system, which has trackted the AIDS epedmic sinc 1987. In 1992 Uganda estamblished the AIDS Comission (UAC) to closly monitory and cordinate the national AIDS strategy.
Major Internatinoal Actors
Since 1987 donar funding has remined a consistent factor in both state and non-state actors. The bulk of donor funds used in government run programmes come from the World Bank Multi-Country HIV/AIDS Program for Africa; The Global Fund to Fight AIDS, Tuberculosis and Malaria; the Great lake Initiative on IADS; the US President’s Emergecny Plan for AIDS Relief; UN agencies; and bilateral resources (Tumushabe, 2006). Non Governmental Organizations (NGOs) and faith-based organizations (FBOs) are also present in local initiviates. In 2001 there were more then 700 govermental and non-governmental organization working within HIV/AIDS issues in Uganda (Green, Halperin, Nantulya, & Hogle, 2006).
The ACP in 1986 lanched an aggressive mass media campasign which allowed for the Uganda Government to provide honest updates about the HIV/AIDS situation. Throughout the early to mid 1990s political support was seen through mass media campaigns supported by the Government and NGOs. Public awarness of issues realted to HIV/AIDS have been broadcast on private radio and televeltion for the public to discuess freely (Green, Halperin, Nantulya, & Hogle, 2006) . During the late 1980’s and early 1990s HIV/AIDS prevention and anti-stigma messages were present on billboards and in the press of health, education and administative departments within Uganda. Stigma attached to HIV/AIDS was addressed these media campagines for education and sensiazation on the transmission of AIDS. Stirght talk is a newsletter that comminicates HIV/AIDS inforamtion including sex and relationsghip adivce to 15 000 secondary student and primate schools as well as 600 community groups (Tumushabe, 2006).
The ABC Approch
Ugandas approch to behavioral change used the ABC apporch which seeks to change behavior around sex and sexual partners to encourge abstience untill marrige, being faithful to one uninfected partner, and encourging condom usage. The National government relied primarily community-based organizations to provide flexible, creative and cultrually appropriate intervention to faciliate behavioral change. The involvoement a verietiy of groups in society for AIDS education and awreness which are not typcally part of the health sector. These included political,community and religious leaders, teachers, leaders in woman and youth groups and grass roots organizations. Key target groups were invloved in AIDS education without creating high stigmiatzing enviornment for sex workers and clients, soldiers, fisherman, long distence truckers, bar girls, police an students (Green, Halperin, Nantulya, & Hogle, 2006). Grassroots organizations emphsiszed womens empowerment, while aiming efforts at older men with disposible incomes who were likely core trasmitters of HIV. Politically efforts were made to empwoer women through giving them more of a voice in parliement, where by law women only hold one third of the positions (Green, Halperin, Nantulya, & Hogle, 2006).
The National government of Uganda relied heavly on an pre-marital abstincence approch to reduction in HIV while attacking condom use as a form of HIV prevention. By the mid-1990s Ugandans had fewer non-regular partners across all age groups. Males (15-17 years old) in 1995 were less likely to have ever had sex, more liklyly to be married and to keep sex witin marriage and much less likely to have multiple partners, partcilarly if never married.
Second to abstince and being faithful is condom usege which untill 1991 was not a central element of Ugandas response to AIDS as political support and relgious support was weak. President Museveni and local religious leaders resisted in promoting condoms. In the 1988 first edition government handbook on AIDS prevention, “The government does not recomond using conms as a way to fight AIDS (UNICEF/Uganda, 1988: 32). However was rewritten to be clarified as, “one can still get AIDS even if a condom is used” (Green, Halperin, Nantulya, & Hogle, 2006). By the mid 1990s the Ministry of Health was distributing condoms in health centers as well as through NGO projects. Condom useage increased among women and men. Women reporting condom use increased from 1% in 1989, to 6% in 1995 and 15% in 2000. While male condom use increased from 16% in 1995 to 40% in 2000 (Green, Halperin, Nantulya, & Hogle, 2006).
President Museveni displayed countinuend resistence to condoms and in May 2004 Museveni is quated, “I am going to review this issue. I will open war on condom sellers. Instead of saving life they are promoting promiscuity among young people. When Iproposed the use and distribution of condoms, I wanted them to remain in town for the prostitutes to save their lives” (Green, Halperin, Nantulya, & Hogle, 2006). Current statistics on condom useage by Uganda AIDS Commission (2012) shows that rates have dropped (see graph for blog) to 13.3% for men and 15.7% for women in 2011.
Although there is sceptizim as to what exactly casued the decrease and stablization of HIV/AIDS rates in Uganda indirectly behavioral changes contributed to decline in prevelnce rates. Although Uganda saw significant declines in HIV prevelence untill stabilizing around 2000 and increased since to 6.7% (Uganda AIDS Commission, 2012). Uganda struggles with providing consisent health facilities throughout the country between urban and rural areas and ehealth can provide helpful soultions to areas lacking adequate prevention stratigies.
Zambia unlike Uganda has yet to see dramatic decreases in HIV prevelence but similarily to Ugandas prevelence rates has since stablized. Although Zambias prevelcne rates are much higher, Zambia has struggled with providing
HIV information in Zambia invloves
Zambia has struggled to minimize HIV transmission, however have made minimal reductions in prevelence. Zambias sucessess include a slight reduction in the adult population with HIV from 15.6% in 2001 to 14.3% in 2007 (2012 UN Report). While among children born to mothers infected with HIV reduced from 7.72% in 1997 to 1.99% in 2011 due to the administation of prophylaxe to prevent mother to child trasmission. This program has reached National coverage of 80% and countiunes to strive for univeral access. Dispite reductions in HIV prevelence, in areas rural men have seen an increase in HIV from 8.9% in 2001 to 11% in 2007 (UN 2012 Report).
Both Uganda and Zambia see higher prevelence rates in rural areas verus urban areas.