Dr. Coutinho would certainly advocate the use of condoms in helping to control the spread of HIV across the African continent. He gained his MBBCh from Uganda's premier institution of higher learning, Makerere University during a period that the 'Pearl of Africa' was being ravished with the illness. The first AIDS case was diagnosed in 1981 in the United States of America and one year later in Uganda, which was among the first hard hit countries. It is estimated that over one million people were living with HIV/AIDS in Uganda by December 2001 and nearly another million had died. Makerere University ranks, as one of the largest in East and Central Africa and it is located on Makerere hill, one of the many hills on which Kampala, the capital city of Uganda is built. Dr. Coutinho seen many patients under his care die of AIDS in his native land before he moved to South Africa to obtain a MPH from the University of Witwatersrand. After graduation he spent some time in South Africa working for the Royal Swaziland Sugar Corporation (RSSC) with responsibility for community services, focusing especially on HIV. In 2001, he joined TASO (The AIDS Supporting Organization) the largest AIDS care organization in sub-Saharan Africa supporting 60,000 HIV+ clients as well as supporting 200,000 children affected by AIDS. The Organisation presently has an annual budget of $6,000,000 to establish services for HIV prevention and care, counseling and testing, as well as hospital management and palliative care for terminal AIDS patients.
During the years of his education, AIDS became the leading cause of death in southern Africa and the crisis posed by the pandemic is growing worse every day. Over 40 million people are now infected by HIV/AIDS; 30 million of those are in sub-Saharan Africa, nearly 5 percent of the overall population of sub-Saharan Africa. This region makes up one-tenth of the world's population, but two-thirds of the world's HIV-positive population and more than 80% of all AIDS deaths occur there. The scope of the problem in some countries is overwhelming. Eleven million African children have lost their parents to AIDS. In Zambia 30 percent of all children are AIDS orphans. In Botswana, nearly 40 percent of the adult population is HIV positive. In 1999, nearly 70% of the 5.6 million new HIV infections occurred in sub-Saharan Africa.
Various factors have contributed to the current AIDS crisis in Africa, including the following:
- The likelihood that the HIV virus originated in Africa and spread and evolved before preventative actions could be taken. There are many theories to support this including the possibility that a Soviet vaccination programme may have inadvertently caused the original illness
- The inability of African nations to pay for the expensive antiretroviral drugs
- The horrific malnourishment and poor health of many Africans
- A fierce denial by many Africans, including the Presidents of some nations, that HIV actually causes AIDS, that condoms are white man's way of controlling their population, that sex education is necessary to stop its spread, and that Western medicine or science cannot be trusted to be seen as a fair broker in this event.
In the midst of this terrible pandemic, a beacon of hope now shines out from Uganda. This nation is poor, rural and in sub-Saharan Africa, three factors that should condemn it to being a helpless case in the eyes of the developed world. Yet, without access to anti-retroviral drugs and with limited health infrastructure, this small country has managed to cut its HIV prevalence rate by one third (from about 15 percent in 1991 to about 5 percent in 2001) and slash the number of new HIV cases by 37%. There is no doubt that the rate of infection has declined and Uganda did this largely through a nationwide campaign focused on the ABC model: abstain, be faithful, use a condom!.
This simple ABC message was disseminated widely through all sectors of society during the late 1980s. By 1990, the percentage of youth aged 15-19 in Uganda ever having had sex decreased noticeably. In 1989, 32 percent of males and 28 percent of females age 15-19 reported being virgins, while by 1995 these numbers had increased to 55 percent of males and 45 percent of females. The decline is even more dramatic for 13 to 16-year-olds in an after school educational program. In the 1990s, sexual debut among girls in Uganda increased from 16.5 to 17.3 years. This does not look like much, but it had a profound impact on the prevalence of HIV/AIDS and it also demonstrated the huge cultural changes that young girls were able to abstain. For boys, it rose from 17.6 to 18.3 years in the second half of the decade.
For youth, the A of the ABC message, abstinence was probably the most important single message. Many people, including Uganda's first lady, acknowledged that the B, be faithful, which includes partner reduction, may be overall the most important factor. While C, condom promotion was not a dominant element in Uganda' s early response to AIDS, (mainly as it affronted the teaching of the Catholic Church), there has been some turn of heart in more recent years and with it, increased condom use. There is a definite beneficial role of condoms when one spouse is HIV positive and the other is not but it must also be seen as an important prevention tool for people who have sex with multiple partners. In Sub-Saharan Africa, HIV is mainly transmitted through heterosexual intercourse. Variances in sexual behaviours across cultures, age groups, and gender usually influenced by culture and social, economic circumstances influence HIV prevention interventions. Dr David Serwadda, a doctor who treated the first AIDS patient in Uganda, says two factors have been key in his country's turnaround. People have cut down the number of sexual partners and young people are starting to have sex at a later age (15.5 years rather than 14).
Dr Coutinho feels the key factor is individual responsibility. He recently told me that he has lost nine close relatives and takes care of two AIDS orphans. "The disease has touched us all!."
If we were realistic, not only is no one in Uganda untouched by this horrific illness, but the difference is that there is acceptance in Uganda that AIDS is the cause of death - rather than the myriad of other causes usually listed to obscure AIDS deaths, as happens in South Africa. This openness is in large part thanks to the fact that Uganda's President Yoweri Museveni has made HIV/AIDS one of his three personal priorities, alongside peace and economic empowerment, for the past 16 years. In an environment where the country's first citizen speaks about HIV every day, it is no wonder that the country's most famous pop star, as well as army officers and an Anglican priest, have felt able to announce to the nation that they were HIV positive.
President Museveni's commitment has created a climate for a unique partnership between the Ugandan government, civil society, and international donors that has led to the formation of a multi-sectoral AIDS Commission to drive AIDS prevention. Dr Coutinho says it is important that Uganda does not rest on its laurels. There are still many challenges, including new infections in the rural areas and only about 5% of pregnant HIV positive women have access to anti-retroviral drugs that prevent them from infecting their babies.
No comments:
Post a Comment