An overarching policy known as “ABC“, which consisted of abstinence, monogamy, and condoms, was set up with the aim of helping to curb the spread of AIDS in Uganda, where HIV infections reached epidemic proportions in the 1980s The prevalence of HIV began to decline in the late 1980s and continued throughout the 1990s. Between 1991 and 2007, HIV prevalence rates declined dramatically. Various claims have been made on the extent of these declines, but mathematical models estimated falls from about 15 percent in 1991 to about 6 percent in 2007
Shortly after he came into office in 1986, President Museveni spearheaded a mass education campaign promoting a three-pronged AIDS prevention message: abstinence from sexual activity until marriage; monogamy within marriage; and condoms as a last resort. The message became commonly known as ABC: Abstinence, be faithful, use a condom if A and B fail. This message also addressed the high rates of concurrency in Uganda, which refers to the widespread cultural practice of maintaining two or more sexual partners at a time. Mass media campaigns also targeting this practice including the “Zero-Grazing” and “Love Carefully” public health messages in the 1990s
The government used a multi-sector approach to spread its AIDS prevention message: it developed strong relationships with government, community and religious leaders who worked with the grassroots to teach ABC. Schools incorporated the ABC message into curricula, while faith-based communities trained leaders and community workers in ABC. The government also launched an aggressive media campaign using print, billboards, radio, and television to promote abstinence, monogamy, and condom use
Condoms were not the main element of the AIDS prevention message in the early years. President Museveni said, “We are being told that only a thin piece of rubber stands between us and the death of our Continent … they (condoms) cannot become the main means of stemming the tide of AIDS. He emphasized that condoms should be used, “if you cannot manage A and B … as a fallback position, as a means of last resort.”
Some reports suggest that the decline in AIDS prevalence in Uganda was due to monogamy and abstinence, rather than condom use. According to Edward C. Green, a medical anthropologist at the Harvard School of Public Health, the promotion of fidelity to one’s partner and abstinence were the most important factors in Uganda’s success because they disrupted the widespread practice of having multiple concurrent sexual partners. Research found that in rural Uganda, the educational messaging regarding condom use was often not effective. In fact, it was found that twenty-three percent of adolescents surveyed did not even know about condoms. A 2004 study published in the journal Science also concluded that abstinence among young people and monogamy, rather than condom use, contributed to the decline of AIDS in Uganda.
However, a field-study conducted in Rakai, a region in southern Uganda, showed that abstinence and fidelity rates had been declining during 1995–2002, but without the expected rise in HIV/AIDS rates, suggesting a greater role for condoms than acknowledged by Museveni. The other central finding of the Rakai study was that, due to Uganda’s focus on prevention of the spread of HIV-AIDS, rather than treatment for those who had already contracted the disease, a large part of the decline in prevalence of HIV-AIDS is due to the premature death of those who have contracted it. This led to the popular play on the ABC campaign, ‘A-B-C-D’, with the D standing for Death. Because only prevalence is measured, incidence can actually increase while prevalence decreases if those who contract HIV are not treated for the disease, thereby dying younger. Later studies have seriously questioned the veracity of Uganda’s miraculous HIV-AIDS claims.
In the 1990s there had been limited access to treatment in the form of anti-retrovirals for those who are HIV positive. As access to anti-retrovirals increased in Uganda, however, studies began to investigate the conflicting social influences on a woman’s desire to continue having children. It was found that while some women felt social obligated to continue reproducing in order to meet a respectable number of offspring, others felt societal taboo and pressure as parents with HIV were thought to be bearing orphans. Through the combined effort of US PEPFAR, the government of Uganda, and international agencies (Clinton HIV/AIDS Initiative, the Global Fund, UNITAID) this has improved. The country’s HIV-AIDS campaign focuses solely on prevention rather than cure, and that prevention is of questionable success.