KAMPALA, 23 January 2013 (PlusNews) - A new Ugandan HIV-prevention campaign that frankly addresses sexual infidelity is generating heated debate over the direction the country's HIV strategy should take.
Billboards erected in various parts of the capital, Kampala, by Uganda Cares - a programme of the US NGO AIDS Healthcare Foundation (AHF) - bear the image of a broken heart and the lines "Cheating? Use a condom" and "Cheated on? Get tested".
The campaign aims to address the growing vulnerability to HIV of couples in long-term relationships. Studies show that some 43 percent of new HIV infections in Uganda occur in such unions.
"Let's be realistic... The HIV infections among married couples are high. So what we are putting across is that if you must cheat, remember to use a condom in order to protect your partner," Mina Nakawuka, AHF's regional director of advocacy and public relations, told IRIN/PlusNews. "Those who cheat must use condoms correctly and consistently. Those who feel cheated [on] must take an HIV test. If we don't do that, we shall not be able to reduce HIV infections in Uganda."
But the Uganda AIDS Commission (UAC), the main government body tasked with managing the country's HIV response, has ordered the billboards be removed on the grounds that they oppose the messages of faithfulness that the government is trying to promote.
"It's totally unacceptable. It's a wrong message. They are confusing people on which HIV prevention messages to follow," said David Apuuli Kihumuro, director general of the UAC. "I have talked to them [AHF]. I have directed them to remove all their billboards. They didn't consult us or the Ministry of Health."
He added, "We are going to talk to the Uganda Communications Commission to regulate such messages and campaigns in the media and public. They shouldn't be allowed. We need messages that encourage people to have faithful lives and live [HIV] negatively."
AHF's Nakawuka said, "We have some issues with UAC, which [we] are sorting out."
Uganda's health minister, Christine Ondoa, told IRIN/PlusNews that the national HIV prevention strategy continues to embrace 'ABC' - a prescription for Abstinence, Being faithful, and consistent and correct Condom use - as well as an array of biomedical interventions. She said her ministry would be investigating "why they [AHF] jumped to C".
The ABC strategy was largely credited with reducing HIV prevalence from 18 percent in the early 1990s to about 6 percent in 2000. However, since then, prevalence has begun to rise again, going from 6.4 percent in 2005 to 7.3 percent in 2011, according to the most recent AIDS Indicator Survey. And despite years of HIV prevention messages, condom use remains erratic.
The government has, in the past, been accused of bowing to pressure from the US President's Emergency Plan for AIDS Relief, which encouraged HIV messages to focus more on abstinence and fidelity and less on condom use, to the detriment of the country's response to the epidemic.
Traditionally, government-backed HIV prevention campaigns targeting couples have focused on less controversial messages such as faithfulness and getting tested.
A 2010 review of couples-focused behavioural HIV-prevention interventions found that while these interventions can reduce unprotected sexual intercourse, there is a need for "stronger theoretical and methodological basis for couples-focused HIV prevention". The authors also recommended that future interventions "pay closer attention to same-sex couples, adolescents and young people in relationships".
The "cheating" billboard has stirred intense debate both on the streets of Kampala and on social media networks like Facebook and Twitter; many hold the view that the campaign's message is tantamount to encouraging infidelity, while others see it as a pragmatic approach to HIV prevention.
"What is their moral motive? I can assure you, it's absolutely wrong and inappropriate to erect such campaign billboards," said Christine Shimanya, an associate vicar at Church of Resurrection, Bugolobi Church of Uganda. "As a church, we don't encourage immorality. If couples have gone off their marriages, the most appropriate intervention is by talking to them, not encouraging cheating. We need Christian post-marital counselling to help them in their morals."
"We don't know the audience the campaigners are targeting," Linda, a news anchor at a local radio station, told IRIN/PlusNews. "They are encouraging people to continue cheating instead of stopping the immoral act. Such messages can't help. Why should people cheat in the first place?. Why should someone risk and put your life, loved ones and relatives at stake?"
The flip side
But a number of Ugandans say the campaign is a welcome shot in the arm for the country's flagging HIV-prevention efforts.
"My impression is that this is a campaign to promote condom use and HIV testing, while acknowledging that multiple, concurrent partnerships are one of the key drivers of new HIV infections in the country," Milly Katana, a long-time HIV activist, told IRIN/PlusNews.
"It needs to be backed up by the message that it is not only those that think their partners have extra sexual partners that need to use condoms or test for HIV, but anyone who has sex with someone whose HIV status they do not know must always and correctly use a condom, and routine testing is a gateway to prevention and eventual elimination of HIV," she added.
Florence Buluba, the executive director of the National Community of Women Living with AIDS, said the campaign's emphasis on condom use was necessary. "If we are to prevent new HIV infections in Uganda, those who cheat and engage in risky sexual behaviours should use condoms, especially if [they] don't know the other person's HIV status," she said. "We should encourage the use of both male and female condoms. The condoms should be made available to all eligible persons and consistently used. The government must invest in it."
James Onen, a popular radio personality, said the message on the billboards was "realistic".
"I think the message will offend the moral hypocrites out there. People tend to pretend on the surface. but cheating is rampant," he told IRIN/PlusNews. "The campaign reminds people to live responsibly and act wisely, which make sense to me."
But both sides of the debate agree that Uganda needs a fresh take on HIV prevention in order to reduce new infections. "We need a new, aggressive and attractive campaign that will reawaken Ugandans about the high HIV infections. People are used to the past messages, which are now stale," said Shimanya.