washingtonpost.com

Uganda's AIDS Decline Attributed to Deaths

By David Brown

Washington Post Staff Writer

Thursday, February 24, 2005; Page A02

"Abstinence and sexual fidelity have played virtually no role"

BOSTON, Feb. 23 -- Abstinence and sexual fidelity have played virtually no role in the much-heralded decline of AIDS rates in the most closely studied region of Uganda, two researchers told a gathering of AIDS scientists here.

It is the deaths of previously infected people, not dramatic change in human behavior, that is the main engine behind the ebbing of the overall rate, or prevalence, of AIDS in southern Uganda over the last decade, they reported.

The findings, not yet published, contradict earlier evidence that attributed Uganda's success in AIDS prevention largely to campaigns promoting abstinence and faithfulness to sex partners. Much of the prevention work in the Bush administration's billion global AIDS plan is built around those two themes, and Uganda is frequently cited as evidence that the strategy

works.

If the report here stands up to scrutiny -- and, more important, is borne out by surveys elsewhere in Uganda -- it will deflate one of the few supposed triumphs to come out of AIDS-battered Africa in the last decade.

The success of Uganda's ABC strategy -- the letters stand for "abstinence," "be faithful" and "(use) condoms" -- has been widely touted and is on the verge of being exported to neighboring countries with the help of American money.

"There is an urgent need to assess abstinence and monogamy in other parts of Uganda," said Maria J. Wawer, a physician at Columbia University's Mailman

School of Public Health who presented the data at the 12th Conference on Retroviruses, the annual mid-winter AIDS meeting in the United States.