July 28, 2014

Uganda: New HIV Prevention Strategies For Youth Are Needed

Schools in Uganda are finding that strategies that used to be effective for HIV prevention must be updated to accomodate a new generation of young people.

Print More


HIV/AIDS prevention initiatives in Kampala, Uganda: An introduction

Children in green plaid uniforms giggle as they run around a tree outside Nakasero Primary School. They pay no attention to a sign nailed to the tree with the words “STAY A VIRGIN” in red above their heads.

A similar sign in an American public school would probably be shocking, but in Uganda this is part of the curriculum.

The Ugandan President’s Initiative for AIDS Communication to Youth (PIASCY) requires schools to teach HIV/AIDS and sexuality. Since 2002, students have learned about reproductive health, life skills, and HIV transmission and prevention beginning in third grade through high school.

But this U.S.-funded program has lost steam. There has been little assessment and modification over the past 12 years, according to Sam Engingyu, senior health educationist for Ministry of Health.

PIASCY was meant to maintain the momentum of Uganda’s nationwide prevention strategy. Uganda is known as a success story because the government’s “ABC” strategy helped lower the prevalence rate from 18 percent in the 1990s down to 6.4 percent in 2006.

But now the prevalence rate is high again. 7.2 percent of the population is HIV-positive, according to UNAIDS.

Research points to a combination of factors for why prevalence rates are up, like little use and access to condoms, few people knowing their HIV status, and dependence on treatments. But even after decades with the disease, lack of education about HIV remains a problem.

“The fact that young people are unaware and uninformed is a major factor of the prevalence rates,” said professor Vinand Nantulya, chairman of Uganda Aids Commission. “Education is most needed.”

Only 39 percent of young people aged 15 to 24 know all the necessary facts about how to prevent HIV, according to the Uganda AIDS Indicator Survey, 2011.

This is especially concerning because Uganda’s population is one of the youngest—56 percent of Ugandans are under the age of 19 years old, and 37 percent of the youth ages 15 to 24 are HIV-positive, according to the Uganda AIDS Indicator Survey.

According to Rosie Nasejje, adolescent counselor for The AIDS Support Organization (TASO), Uganda’s largest NGO:

“Most youth are ignorant to how heavy this disease is. They just don’t fear the disease like we used to because they don’t see people sick and dying from it like in the past.”

Teachers can’t do it all

Ugandan schools simply have too many students and not enough time for effective HIV and sex education.

“PIASCY has no time allocation on the timetable,” Jesse Waiswa said, social studies teacher at Wabulungu Primary School in Jinja, Uganda. “When it is talked about daily, that is when it is effective.”

Lewis Bukenya Denis, training manager at Naguru Teenage Information and Health Centre in Kampala, explained that sex education should be embedded in the curriculum:

“When we come to schools and ask for time to teach sex education, it looks like it is a foreign thing that should not be part of school. Yet we are seeing that it is one of the essential things students need because many young people who don’t have sexuality education don’t even finish their schooling.”

Delivering PIASCY-approved messages and information is only part of teachers’ role in educating youth on HIV. They act as counselors, and even parents to students who lack guidance at home.

Yusuf Nsubuga, director of basic and secondary education and HIV/AIDS sector coordinator for Ministry of Education stated:

“In our culture here, it has always been taboo for people to talk about sex and sexuality. Even with high prevalence, parents feel they cannot openly talk about it to their children. That is why it’s so important for teachers to inform young people.”

American teachers also council students, but the issues Ugandan teachers deal with are typically more severe. Many Ugandan students are orphaned from HIV, are HIV-positive, or live in extreme poverty yielding a laundry list of daily challenges.

That does not mean all teachers are qualified to counsel in these topics. Denis once trained a group of teachers on sexual health who were so embarrassed they could barely name parts of the body, like penis and vagina.

Counselors are a staple part of American schools. In Uganda, counselors are rare. Brenda Nakirya, founder of a community group that holds counseling sessions in schools named Community Concerns Uganda, said this is what schools need most.

For youth, by youth

Prossy Namugomya is an HIV-positive college student in Kampala. She never felt comfortable going to her teachers for help.

“In high school I felt very alone,” Prossy said. “I feared that students may suspect my status and discriminate me.”

Many times HIV-positive students drop out of school because of the social isolation and discrimination they face.

PIASCY does a reasonable job addressing sexuality, but the program has not done enough to accommodate the growing population of positive students. Now the issue is sensitizing teachers and students to their HIV-positive peers.

“Teachers are not equipped enough,” Prossy said. “They still need more information to stop stigma.”

In 2012 a survey commissioned by the Ministry of Education and Sports found that over 400,000 students, teachers and staff were HIV-positive, making up nearly a quarter of the entire infected population. Still with this number, the fear of stigma keeps positives in hiding and often leads to unsafe sex.

Just as PIASCY has done little to address the increase of HIV-positives in schools, the messaging has not changed.

Abstinence has been drilled into students’ heads, but is this having an effect on behavior?

Ekima Emmanuel, student at Makerere University, explained that abstinence-only education has over-lived its time:

“At school we were always told ‘abstain,’ which in reality cannot be made, because of various circumstances. There is going to be a time when a person can no longer abstain. What next? This is the kind of information young people lack.”

PIASCY only teaches abstinence, much of the reason why USAID and PEPFAR decided to fund the program in the first place. Information about condoms is supposed to be taught to secondary classes, but schools are not allowed to encourage condom use or give them to students.

“Schools act like students aren’t having sex,” Prossy said. “When I look back to when I was still in high school, students were even having sex in classrooms…we should encourage condom use because students are not abstaining anyway.”

Students often are left with rumors about HIV and sexual health. Myths still circulate, like it’s better to wear two condoms or having sex with a virgin will cure HIV.

According to BrianTumusiime, a student at Nkumba University:

“There is a big gap in the communication of information between those who do know and those who don’t know. A reason why this information is not reaching us is because these well-informed people are not bringing it down to the young people.”

Jacquelyne Alesi, program director for Uganda’s Network for Youth Living with HIV and AIDS, believes an intervention created by young people for young people needs to be rolled out:

“The mistake was that PIASCY was not developed by young people. They should revise it and bring youth and HIV-positive people on board.”

Read the full report here, and read the published version of this article from the Daily Monitor newspaper in Kampala, Uganda here.

Hannah Crane is a recent graduate of the IU School of Journalism. Hannah’s love for writing, connecting with people globally through social media, and the mission of The Kinsey Institute naturally led Hannah to become involved during her career at IU. She currently is a junior content specialist for IU Communications.