"women and men get AIDS not because they are stupid..."

This past week - amidst celebrating the passing of another year in my life and eagerly anticipating the birth of a baby in a colleague’s life - I also managed to attend the official launch of the “Year of Accelerated HIV/AIDS Prevention in Uganda.” Held under a party tent at the “Country Club” in Kampala, it was a truly Ugandan event: it started 2 hours late, opened and closed with prayer, and was punctuated by skits and songs. Uganda’s Vice President Dr. Gilbert Bukenya gave the keynote speech. The theme of the songs, skits, and speeches alike was HIV/AIDS prevention.

Much of the information discussed was percentages and trends that by this time I know better than I know how to spell my street address or what digits make up my cell phone number. The national HIV/AIDS prevalence rate is 6.4% among people aged 15 – 49 years; urban residents have a significantly higher rate of HIV infection than rural residents (10% and 6% respectively); prevalence rates for urban women is 13% as compared to urban men which is 7%. Currently approximately 70,000 out of the 120,000 Ugandans in need of ART (antiretroviral therapy) are being treated. However there are approximately 100,000 new HIV/AIDS infections each year. A combination of (relatively) accessible treatment alongside widespread infection has made many Ugandans consider AIDS normal – a bit like how extreme violence on the evening news is common in the United States. There is a lot that is alarming about it and it could be combatted, and yet its become normal.

The fact that 13% of urban Ugandan women as opposed to 7% of urban men are HIV positive is indicative of the fact that here, like much of the world, women are suffering disproportionately from HIV/AIDS. This has been universally acknowledged (in part because it is impossible to deny) however there remains the question: what to do about it?

Most HIV/AIDS education strategies focus on sex as a threat to life but do not pay attention to why people have sex. Many HIV/AIDS interventions have a gender component but none target men. The majority of HIV/AIDS programs consider individuals in isolation not in the context of the relationships they live in. Yet the reality is:

Ugandan men tell me that of course they do/would/will have extramarital sex – “manliness” is equated with the number of women one has “conquered.” Among men, HIV prevalence increases as their number of partners increases. Ugandan women explain that they are expected to be obedient to men, they cannot question the infidelity of their husbands/boyfriends nor can they deny them sex. Approximately 60% of new HIV infections occur within married relationships. The majority of Ugandan women lack access to their own income and must offer their bodies to men (husbands, boyfriends or strangers) in order to earn a living, to buy clothes for their children and to buy food. 83% of women have not discussed AIDS with their partners, often due to fear of domestic violence, abandonment or marital disruption.

And yet the Vice President’s launch of the government’s new HIV/AIDS prevention strategy made little mention of women, men or gender. Instead the focus was on children watching immoral movies.