A most interesting success story in the realm of health comes from Uganda, which in 1982 was the first African country to identify Aids. By the mid-1980s, Uganda had one of the highest HIV prevalence rates in the world, which continued to rise in the next decade and a half. In the 1990s, however, remarkable declines were observed across a number of surveillance sites measuring HIV prevalence in pregnant women and towards the end of the 1990s the country was upheld as a model nation in the fight against HIV and Aids. And although some of these gains were reversed in the forthcoming decades, it is nonetheless important to understand this amazing achievement in the 1990s for a country that was confronted with numerous political and developmental challenges.
According to scholars Justin Parkhurst and Edward Green, a combination of factors was responsible for Uganda’s success. First, there was high-level political support within the country with the president claiming that fighting Aids was a “patriotic duty”, requiring openness, communication and strong leadership at all levels. Uganda quickly developed a National Aids Control Programme, which in turn helped mount and coordinate a multi-sectoral response involving national and international development agencies and bilateral donors.
Second, rather than focusing on one strategy, the government adopted an inclusive approach and consulted with numerous stakeholders – including local organisations – while developing its policy options. President Museveni’s administration also engaged strategically with the international community and reconfigured its response to HIV and Aids to fit the agendas of the most influential development actors of the time, which included forging a strategic alliance with the World Bank and partnering with bilateral donors in accessing resources from so-called “trust funds”.
Third, there was a strong focus on decentralised planning and implementation aimed at behavioural change. Religious leaders imparted Aids prevention messages from the pulpits and faith-based organisations actively promoted the use of condoms. There was also a considerable focus on confidential voluntary counselling.
Fourth, the strategy to combat HIV and Aids placed a considerable amount of emphasis on women and youth and combated stigma and discrimination by providing community-support and awareness of the disease through an aggressive public media campaign at national and local levels. There was a conscious attempt to combat stigma by encouraging individuals and communities to openly talk about HIV and Aids. Indeed, some have characterised the Ugandan experience as a successful prescription of a “social vaccine” that emphasised the importance of open communication and community-based support.
But also Malawi has achieved success. While the average life expectancy for Malawian women was 51 years in 2005, it rose to 65 years in 2016. And Malawian men can now on average expect to live for 60 years as compared to 48 years in 2005. One of the many reasons for this success has been an impressive reduction in HIV prevalence rates since antiretroviral therapy was scaled up in 2004. According to UNAids, Malawi has been one of the biggest success stories in Sub-Saharan Africa, having reportedly saved over 260 000 lives since 2004 and achieved a 67 per cent reduction in the number of children acquiring HIV. The country has also achieved a 46 percent reduction in new HIV infections since 2010. Despite these achievements, urban Malawians remain disproportionately affected, and women and youth are still most at risk of contracting HIV. n