Battling Old Behaviour the New Front in AIDS Fight

This article looks at the history of of multiple concurrent partners on the HIV pandemic in Uganda, and a new campaign initiated by Population Services International (PSI) that aims to discourage the "Sugar Daddy" phenomenon. The article argues that a new resurgence in HIV infection in Uganda has been spurred on by an increase in multiple concurrent partnerships. According to the article, although campaigns discouraging the practice in the 1980s led to a decline in HIV prevalence, recent campaigns have shifted the focus to other aspects of prevention, leading to a new generation that is largely unaware of the risks associated with multiple concurrent partners.

A PSI survey found that more than 16% of young women at university have had multiple sexual partners in the past 12 months, many in concurrent relationships with Sugar Daddies and boyfriends. About 36% think such relationships are normal. According to the article, at night, expensive cars stream into university parking lots near the girls' dormitories where Sugar Daddies meet their girlfriends or take them out on dates.

The campaign involves churches, who use the pulpit to preach against cross-generational sex. Priests and ministers encourage families to talk to their children about the taboo subject of sex and the risks of such relationships. National figures like First Lady Janet Museveni and the Queen of Buganda are also participating. "Go Getter" clubs at universities were created to teach girls life and work skills to foster "self-esteem and empowerment" so they rely on themselves, "not a rich Sugar Daddy."

The article explains the history of the epidemic in Uganda and President Yoweri Museveni's "ground-breaking and powerful" "love carefully" and "zero-grazing" campaigns. The message was blunt - be faithful because AIDS kills. (Zero-grazing is a farming term than means keeping cattle in one pasture rather than letting them roam.) A World Health Organization study showed more than a 50% reduction in number of people reporting multiple and casual partners between 1989 and 1995. The number of Ugandan men reporting three or more non-marital sexual partners fell from 15% to 3% during the same period. The article points out that today's teenage girls weren't even born during president Museveni's aggressive "zero-grazing" campaign in 1980s that instilled fear into men and women about their personal risks of getting infected by sleeping with multiple partners.

In the article, Dr. David Halperin proposes that Uganda shifted from Mr. Museveni's clear "zero-grazing" message to an emphasis on other prevention policies and programmes - abstinence, condoms, HIV testing, antiretroviral drug treatment, and fighting stigma and discrimination. By the mid-1990s, that message was getting muddy. First, came major condom campaigns, which inadvertently told people they could have multiple partners as long as they used condoms. Then came First Lady Janet Museveni, a devout Christian, preaching abstinence, telling youth not to have sex until marriage. The ABC approach - Abstain, Be faithful and use Condoms - came under fire for channeling money, often through faith-based organisations, that promoted abstinence over condoms. As politics and ideology took over, the "be faithful" of the ABC strategy got lost in the confusion and HIV infections inched back up.

The Sugar Daddy campaign borrows from Museveni's "zero-grazing" drivers that are said to have helped stop new infections 20 years ago - empowering women and mobilising church, political, and community leaders. The article says that the Sugar Daddy campaign, which consists of large billboards posted around Kampala, is an attempt to promote faithfulness by eliminating the socially acceptable practice of cross-generational sex. It aims to shame the men who do it, outrage the community that accepts it, and build the self-esteem of young women to reject it. The article states that although the campaign is praise-worthy, it alone is not enough, as it is women in their 20s and 30s - often already married - who make up the highest risk group in the country. The author says that the campaign will only delay HIV infection if adult behaviour changes.