XUNICEF Quarterly June 2021

HIV/AIDs Programming in Uganda…the early days

Sally Fegan-Wyles

Uganda was the first country in Africa to openly recognize the epidemic. Locally called ‘Slim disease’, because of the disruption of the population, and the movement of troops, it had spread very quickly in southern Uganda. President Museveni understood the need to be open about it as soon as he realized how bad it was. 80 out of 100 Ugandan soldiers sent to Cuba for training tested positive in 1986.

Like everyone else, in UNICEF Uganda we first thought AIDs was not an issue for us, as it was a disease of homosexual adult men. But when the link between Slim disease and AIDs was established, we started to see the consequences for women and children. We were working closely with Nsambya Hospital in Kampala, and when they told us that 33% of the women attending Ante-Natal care were HIV positive, we began to think about what we could do, starting with public information initiatives.

I went to the Global meeting of UNICEF Reps in Mohonk, New York, end of 1986, or early 1987. I had just become a Representative, and I was very nervous about speaking, but I had to say something when the discussion on falling IMR/UMR rates was painting a very positive picture for continued progress. Although we did not know how many babies born to HIV positive mothers would die, we knew that many were dying in Kampala. So I raised my hand, and told the room about the high levels of infection of pregnant women, and that there had to be negative consequences. As I recall, there was general discussion, but no clear direction for action yet.

On my return to Kampala, I was having my monthly telecon with George Kassis, (desk officer for Uganda, and the best desk officer I ever had). I was telling him about our health education project, and wondering about expanding it. He told me that I had to think much bigger, and that I would have no problems fund raising, or exceeding our Programme Budget. So we did.

We focused on public information through the radio, the health services, and the education system, working with Government, NGO’s and churches. Everyone was alarmed by the numbers of people visibly ill, or dying, at this stage, so there was real willingness to take action, but also real reluctance to openly discuss sex, or condoms. Sometimes this led to very weird conversations, like when we were trying to destigmatize Condoms in a meeting with all the education senior managers in government, and a Danish JPO working with us had me demonstrate how to blow up a condom over my head, by stretching it down over my face, and blowing air through my nose until I had a condom cone head!

We persuaded the catholic church that we were not dealing with contraceptives, but rather the condoms were ‘contra-infectives’, and when used for that reason, they were permissible. And we persuaded the parents associations that the schools would not teach sex education, only AIDs prevention.

By 1989 we had a large behaviour change programme going, with widespread report inside Uganda, and from donors. Sadly, the only opposition came from another UN agency, WHO. They initially tried to maintain that this was purely a medical issue, and that we should stay out of it. I had some really unpleasant conversations in Kampala, where they basically said ‘you have taken over EPI, we are not going to let you take over HIV/AIDs’. The climax came when Jonathan Mann, then head of AIDs in WHO, visited me in Kampala, and told me to back off, or he would complain about me to Jim Grant! Needless to say, we did not back off, and when Peter Piot took over, everything changed and we became the great partners we always should be.

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