CHAPTER FOURTEEN: World Environment

Using the Perspectives

Sam Ruteikara, co-chair of Uganda's National AIDS-Prevention Committee, is concerned with the Western world's approach to fighting HIV/AIDS in Africa. In a recent Washington Post commentary piece Ruteikara urges a more local-led approach.

Ruteikara writes, "In the late 1980s, before international experts arrived to tell us we had it all 'wrong,' we in Uganda devised a practical campaign to prevent the spread of HIV. We recognized that population-wide AIDS epidemics in Africa were driven by people having sex with more than one regular partner. Therefore, we urged people to be faithful. Our campaign was called ABC (Abstain, or Be Faithful, or use Condoms), but our main message was: Stick to one partner. We promoted condoms only as a last resort. PEPFAR [The President's Emergency Plan for HIV-AIDS Relief] calls for Western experts to work as equal partners with African leaders on AIDS prevention. But as co-chair of Uganda's National AIDS-Prevention Committee, I have seen this process sabotaged. Repeatedly, our 25-member prevention committee put faithfulness and abstinence into the National Strategic Plan that guides how PEPFAR money for our country will be spent. Repeatedly, foreign advisers erased our recommendations. When the document draft was published, fidelity and abstinence were missing."

1.  What, according to Ruteikara, is driving the AIDS epidemic in Africa?
     

2.  How does PEPFAR violate the approach of Millennium initiative development experts?
     

Ruteikara is concerned that donor experts will ignore locally identified needs and goals.

"When Washington insiders were alerted to these scandals, the words 'abstain' and 'be faithful' were quietly reinserted into the plan--on paper. But that doesn't guarantee these methods will be implemented or promoted. . . . As fidelity and abstinence have been subverted, Uganda's HIV rates have begun to tick back up. Western media have been told this renewed surge of HIV infection is because there are 'not enough condoms in Uganda,' even though we have many more condoms now than we did in the early 1990s, when our HIV rates began to decline. Condom promotions have failed in Africa, mostly because fewer than 5 percent of people use condoms consistently with regular partners. Indeed, the loudest HIV-prevention message in Africa is 'universal access' to condoms, testing, anti-retroviral treatment, and assorted other drugs and devices. All these commodities must be transported, stored, distributed, advertised and resupplied endlessly. Meanwhile, effective HIV prevention methods, such as urging Africans to stick to one partner, don't qualify for lucrative universal-access status. Do not misunderstand me: Treatment is good. But for every African who gains access to HIV treatment, six become newly infected. To treat one AIDS patient with life-prolonging anti-retroviral drugs costs more than $1,000 a year. Our successful ABC campaign cost just 29 cents per person each year."

3.  According to Ruteikara what is wrong with the "one-size-fits-all" approach?
     

4.  How would an identity perspective scholar assess this particular situation?
     

5.  How does culture play a role in identifying solutions for disease prevention?
     

6.  What do you think of Mr. Ruteikara's concerns?
     

Sam L. Ruteikara, "Let My People Go, AIDS Profiteers," Washington Post, June 30, 2008,
http://www.washingtonpost.com/wp-dyn/content/article/2008/06/29/AR2008062901477.html