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Program Services News

Success in Uganda

Uganda is widely considered to be one of the world’s earliest and greatest success stories in subduing a generalized HIV epidemic.  The number of HIV infections increased rapidly throughout the country and by 1988, Uganda had the highest rate of HIV infection in Africa. By 1992, HIV prevalence in major urban areas was as high as 30% among women receiving antenatal care at sentinel surveillance sites.  Then in 1993 in Kampala and at different times at other sentinel sites, a marked decline in HIV prevalence began among these antenatal women. By 2001, prevalence had declined by more than half in both urban and rural areas.  No other country has had such high rates of HIV infection followed by such large declines. 

Given this success, it is important to understand 1) the behavioral changes that led to the decline in HIV prevalence and 2) the policies, interventions and other factors that led to the behavior changes.

Five reports explore different aspects of Uganda’s success.  Although their contents overlap, they have different purposes and are designed for different audiences. 

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Published Article

This article has been published in Sexually Transmitted Infections following peer review.  It can also be viewed on the journal’s website at http://sti.bmjjournals.com/

Download the Reports

• Success in Uganda:  A Brief Summary
  

  This 3-page summary incorporates the most important conclusions and policy implications gleaned from this project.  It is designed to be given out as a handout at speeches and other meetings.

• Success in Uganda:  An Overview of Uganda’s Campaign to Change Sexual Behaviors and Decrease HIV Prevalence, 1986-1995
  

  In contrast to the 3-page handout, this 24-page overview provides a more in-depth summary of both the specific behaviors that led to the reduction in HIV prevalence and the programmatic efforts that were implemented to change behavior.  It summarizes nine types of evidence and concludes with implications for other countries with generalized epidemics.

• Success in Uganda:  An Analysis of Behavior Changes that Led to Declines in HIV Prevalence in the Early 1990s
  

  This report focuses on the evidence for changes in specific behaviors.  It is written for those who are interested in which sexual behaviors (or which changes in sexual behavior) most contributed to the decline in HIV prevalence.  It presents nine different types of evidence (e.g., modeling of HIV incidence and prevalence, reports of behavior change in newspapers, survey data about behavior, interviews with focus groups and key informants, reports of shipments of condoms to Uganda and historical documents describing programmatic efforts to address AIDS).  These different types of evidence produce a consistent picture demonstrating that people first restricted their sexual behaviors and were more faithful and then increased their condom use if they had sex with non-marital/non-cohabiting partners.  This combination proved to be a powerful one. 

• Success in Uganda:  A Review of Programmatic Approaches to AIDS Prevention and Their Impacts, 1986 – 1995
  

  This report focuses on the efforts to change sexual behavior and thereby reduce HIV transmission.  It is designed for those readers who want more detailed information about the programmatic efforts that led to behavior change nationally.  It covers efforts by the President of Uganda, the national government, local councils, non-governmental organizations, media, health care providers, schools, faith communities, employers, the military, condom promoters and distributers and HIV testing centers.  It describes the content of messages about sexual behavior.  It provides a logic model identifying the major programmatic efforts and their collective impact on important psychosocial mediating factors, such as knowledge about HIV, perceptions of risk, social norms regarding multiple partners, self-efficacy to limit sexual risks and attitudes towards condoms.   Finally, it briefly summarizes the impact of these efforts on behavior and concludes with implications for other countries with generalized epidemics.

• Success in Uganda:  A History of Uganda’s Successful Campaign to Reduce HIV Prevalence in the Early 1990s
  

  This report provides a detailed historical analysis and timeline of exactly what occurred when.  It is designed for those more interested in history or in the timing and sequence of events and the implications of the sequencing for the causal impact of different factors.