The plague that won't go away

Nations must adopt tough public policies

July 11, 2000|By James Kiwanuka-Tondo

STORRS, Conn. -- During discussions in South Africa about ways to effectively fight AIDS in Africa, researchers would be advised to study Uganda, which has cut its HIV infection rate from 33 percent in the early 1990s to 12 percent today.

The East African country was able to produce such a dramatic drop by recognizing the gravity of the problem, adopting an open public policy and waging a vigorous AIDS prevention campaign. The same strategy should work in other countries that have the courage and the will to learn from Uganda's experience.

As early as 1986, Uganda's government acknowledged that the country was facing an epidemic of enormous proportions. At that time, the United States and many other countries continued to deny the existence of a problem.

In Africa, some countries, such as Kenya, still don't want to acknowledge the problem because they fear such an admission will ruin their tourism industry. By looking at Uganda, where tourism grew 400 percent in the early 1990s despite a high rate of growth of AIDS, it's apparent that this simply isn't true.

In developed countries, drugs that allow AIDS-infected people to live longer, healthier lives have contributed to the belief that the epidemic is under control. But these drugs are not and will not be affordable in developing nations in the near future. Even in developed countries, many people can't afford these costly drugs. Instead of denying the problem, governments must establish open public policies, as Uganda did.

In 1986, Uganda's government, with the support of the World Health Organization, established the AIDS Control Program as a model for the rest of Africa. Soon after this, numerous organizations rushed to the scene to assist AIDS victims and wage a vigorous campaign against AIDS.

By 1992, more than 300 organizations in Uganda were dealing with AIDS-related problems. That year, the government established the Uganda AIDS Commission to coordinate all AIDS-related programs. This enabled the organizations to combat the problem together and curtailed the duplication of very meager resources.

The government also appointed a Presidential AIDS Commission and adopted an approach to AIDS that involved all government agencies and the private sector in the fight against the disease.

The open public policy encouraged a candid discussion of the AIDS problem at political rallies, religious ceremonies, schools and civic activities.

But stopping the denial and having an open public policy are not enough. These must be accompanied by vigorous communication campaigns, as demonstrated by Uganda.

A recent survey of 91 organizations running AIDS prevention campaigns in Uganda shows that for any organization to run a quality campaign, it must have plentiful financial resources and a well-trained staff. It also needs a focus of purpose and a flexible and less formal organizational structure that allows the participation of the audience in the planning, designing and implementation of the campaign.

More than 68 percent of the surveyed organizations had at least one staff member with training in running and designing communication campaigns. In the United States, recent research shows that in many organizations that run communication campaigns, the staff members are health workers without any communications training.

The communication campaign literature has until recently been silent about the training of staff. Yet recent research in Uganda indicates that this element was key to the quality of the AIDS communication campaigns there.

In addition, research in Uganda shows that organizations that were more focused limited their activities to running AIDS communication campaigns. Many organizations elsewhere are simply trying to do too many things at once. There is a dire need for all organizations to focus on one activity at a time.

Organizations should always conduct research about their target audience, use multiple channels for their messages, target narrow audiences and supervise their outreach workers. In Uganda, these elements were crucial since they led to the success of the AIDS prevention campaigns.

Uganda's declining rate of AIDS infection provides a glimmer of hope to nations being ravished by the disease. By studying Uganda's successful AIDS prevention campaigns, other countries can learn practical and theoretical lessons that can save lives and loosen AIDS' grip on developing nations.

Dr. Kiwanuka-Tondo, a native of Uganda, is a visiting assistant professor at the University of Connecticut.

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