Word of mouth leads to safer sex.
There are 70% fewer cases of HIV in Uganda now compared with ten years ago, research reveals. It is a success story that highlights the power of local communities to initiate change and shows how prevention strategies can work.
The disease is less prevalent because people are limiting their number of sexual partners, says Daniel Low-Beer from Cambridge University, who co-authored the research. He believes this has happened because friends, family and social networks are talking about HIV, the virus that causes AIDS, and spreading the word about preventing infection.
The researchers studied the medical and behavioural records of thousands of pregnant women and army recruits in Uganda and neighbouring Malawi, Kenya and Zambia. Extrapolating from those figures to the whole population, the team report in Science1that half a million Ugandans are HIV positive now, compared with 1.5 million a decade ago.
"It is a massive decline," says HIV researcher George Rutherford from the University of California, San Francisco, who was not involved in the study. "It is unprecedented in the developing world." The survey also reveals that there is 60% less casual sex in Uganda now than ten years ago.
Uganda's achievement is something of a one-off in a continent where the HIV epidemic is still growing. Success is in part due to rapid response mass media campaigns.
Twenty years ago, when infection was at its peak, billboards, radio shows and concerts shouted a coordinated anti-HIV message. Public figures, including politicians, religious leaders and health workers, promoted safe sex and people began to use condoms more often.
But similar strategies in other African countries did little to lower the prevalence of HIV. So why was Uganda so successful?
Care in the community
The difference is that in Uganda people became engaged with the epidemic at the community level, says Low-Beer. Local care groups, religious movements, non-governmental organisations and care networks all spread the message. Families, friends and neighbours began talking about HIV prevention and care, and sexually transmitted diseases stopped being a taboo topic.
The issue also became personal, says Low-Beer. Most people now know someone who has AIDS or has died from the disease and this has motivated people to change their behaviour.
The situation echoes San Francisco in the late eighties when HIV had a stranglehold on the gay community. The best predictor of behavioural change back then was knowing someone with HIV or AIDS.
Low-Beer says that it is not too late for other countries to involve communities in spreading the word about HIV and AIDS, as long as policy-makers take into account social factors such as religion and attitudes to women. "Change is within the capabilities of other African countries," he says.
Stoneburner, R. L. & Low-Beer, D. Science, 304, 714 - 718, (2004).
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Pilcher, H. Uganda's HIV epidemic wanes. Nature (2004). https://doi.org/10.1038/news040426-15