AIDS: The Lesson of Uganda

In 1982, Uganda became the first African country to identify patients suffering from the same disease that was killing homosexual men, heroin addicts, and hemophiliacs in Europe and the US. However, it soon became clear that AIDS in Uganda was different, because it seemed to affect everyone: housewives, businessmen, taxi drivers, hairdressers, teachers, small children, soldiers, policemen, civil servants, doctors, and nurses. Millions of people are infected with HIV in the United States, Russia, India, Thailand, and other countries, but in these places infection is associated with risky behavior, such as prostitution, intravenous drug use, and unsafe gay sex.

However, in Uganda, as in much of East and Southern Africa, few families have been spared. In such major cities as Kampala, Gaborone, Johannesburg, Harare, and Lusaka, between 10 and 40 percent of all adults carry HIV. Not only is sub-Saharan Africa in a class by itself when the global spread of the epidemic is considered, but HIV is creating new forms of inequality within particular countries. In this way, HIV has been seen as an indicator of social injustice, both globally and locally. It infests some of the most fragile nations on earth, and increasingly strikes the weakest men and women within them. Meanwhile, infected people and their families are now making up a new social class, excluded from the best jobs and schools and from the warmth of human relationships.

I first visited Uganda in 1993, when I went there to work on an AIDS vaccine project for an American biotechnology company. In 1995, when I left, Uganda was a hopeful, mostly peaceful country. Its president, Yoweri Museveni, came to power by force in 1986, after his National Resistance Army displaced the weak Tito Okello. Museveni promised to redress the corruption and brutality of the governments of Milton Obote and Idi Amin, and he did bring peace to most of the country, although fighting with rebels continues to this day in some northern districts. Museveni has forbidden campaigning by political parties other than his own National Resistance Movement, but he has encouraged limited forms of democracy. In 1989, parliamentary elections were held, and in 1997, Madeleine Albright hailed Museveni as one of Africa’s “strong new leaders” who had brought order to one of the poorest countries in the world with one of the twentieth century’s most brutal histories.

Uganda is one of the few countries where Structural Adjustment, the World Bank’s economic program based on economic liberalization and privatization, civil service reform and reduced government spending, has been moderately successful. The economy grew by about 6 percent a year throughout the 1990s, and Uganda is now exporting coffee, sesame seeds, fish, tea, cotton, and other commodities to the rest of the world. According to the World Bank and the Ugandan Bureau of Statistics, the number of people living in poverty in Uganda fell from 56 percent in 1992 to 35 percent in 2000. While these statistics have been questioned, and poverty in some rural areas …

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