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August 11, 2004

New Tactics, Old Adversary

Four Ugandan Members of Parliament Gain New Skills to Lead Their Country’s Fight Against AIDS

Unlike other African countries that were slow to react to HIV/AIDS, Uganda began actively confronting the epidemic more than 15 years ago. An early and committed response by Uganda’s political leadership helped roll back national HIV prevalence rates from an estimated 18.2 percent in 1992 to 5.8 percent today.

But today’s political leaders are wary of claiming success against a disease that has infected 25 million Africans, killing 2.2 million last year. “We have to be proud of what we have achieved, but we don’t want to talk of a success story because this [HIV prevalence rate] is still unacceptable,” says David B. Matovu, PhD, a member of Uganda’s Parliament. “With achievement, we have risk of complacency. The next step is treatment.”

Members of the Ugandan Parliament (l to r): David B. Matovu, Elioda "Elly" Tumwesigye, Jesca Eriyo and Johnny Bulamu

Members of the Ugandan Parliament (l to r): David B. Matovu, Elioda "Elly" Tumwesigye, Jesca Eriyo and Johnny Bulamu

Matovu, three fellow members of the Ugandan Parliament and other parliamentarians from around the world came to the Johns Hopkins Bloomberg School of Public Health on August 1 for a weeklong leadership seminar sponsored by the School’s Bill and Melinda Gates Institute for Population and Reproductive Health.  The 11 parliamentarians received training in everything from strategic leadership to HIV and human rights, and population and development issues.

Since the Ugandan delegation are all members of their Parliament’s Standing Committee on HIV/AIDS, they were eager to apply what they learned in the seminar to their situation. Despite the success of Uganda’s education and prevention campaigns, AIDS remains a significant problem in the country of 26 million. And the epidemic’s spread in other African countries raises serious concerns. An estimated 3 million Africans were newly infected with HIV in 2003 alone, according to UNAIDS. Seven countries in southern Africa have HIV prevalence rates above 17 percent.

The statistics encourage the Ugandan parliamentarians to discover better ways of designing programs to fight the epidemic. “We always had the approach of top to bottom,” says Elioda “Elly” Tumwesigye, MBChB, chairperson of the AIDS committee. “[But] interventions need to be designed with the household level.”

Fellow Member of Parliament Jesca Eriyo said the seminar impressed on her the importance of gathering information first at the household and community level, rather than relying on “mental models”—one’s assumed version of reality. “It’s better to come earth and face the realities rather than what you have in mind,” Eriyo says.

The seminar encouraged Matovu to seek out more data- and science-based insights in the campaign against HIV in Uganda. “We have learned to marry the academic and science approach with political leadership,” he says. “We can come up with a more scientific approach that brings the academic and political together.”

As members of the AIDS committee, the group has been instrumental in developing national policy and monitoring prevention and other AIDS-related efforts. Tumwesigye says committee members have been to 26 of the country’s 56 districts to monitor programs supported by the World Bank, USAID and other organizations, removing barriers to their work and ensuring that funds are being spent appropriately. “The committee is charged with advocacy and also with policy analysis,” says Johnny Bulamu, MD. “Its duty is to keep Parliament informed of its monitoring function of HIV/AIDS activities in the whole country.”

The committee also has held hearings on AIDS issues, including treatment. The government is eager to begin nationwide distribution of anti-retrovirals with the support of UN agencies, the United States, and others.

Says Matovu: “We want to have this treatment—though it’s not a cure—to keep these infected people alive—”

Eriyo agrees. The more adults kept alive, the fewer AIDS orphans. “We are already overwhelmed with orphans, ” she says.—Brian W. Simpson