UGANDA: Row over HIV/AIDS success story

NAIROBI, 23 August 2002 (PlusNews) - A leading scientific journal, The Lancet, has questioned Uganda's HIV/AIDS "success story", saying that it is based on flimsy evidence.

Despite being widely regarded by the international community as having very successfully lowered the rates of HIV/AIDS, the basis for the Ugandan claim of success has rarely been critically investigated, wrote Justin Parkhurst of the London School of Hygiene and Tropical Medicine, in an article published last month.

President Yoweri Museveni announced in June that rates of HIV infection were down to 6.1 percent this year from 30 percent in 1990, The New Vision Ugandan state-owned newspaper reported. Parkhurst says that "selective information" has been used to compile such official figures. "Statements of success have often been based on misinterpretation of epidemiological data, and can sometimes not be supported when all the Ugandan evidence is assessed."

While he commended Uganda on being the first African nation to establish a national response to HIV/AIDS, and on successfully lowering rates of infection, he said information from a small number of urban antenatal clinics - hardly indicative of the whole of Uganda where about 87 percent of the population lived in rural areas - appeared to be the basis for the statistics, and was therefore not representative. "Unfounded claims of Ugandan success have persisted in international policy discourse," he noted.

Furthermore, claims that the rates of infection had decreased were at times based on the rate of prevalence - as opposed to the rates of infection per year - which can be distorted significantly due to the number of people dying each year. "Successful HIV-1 prevention cannot be claimed until a decrease in the number of new infections which each year (measured as incidence) occurs," he said, adding that the term "HIV rate" was used ambiguously by many people.

Another frequent "mistake", he said, was "the notion" that the decline in prevalence was due to a few specific interventions by the Ugandan government. He emphasised that the government was but one player - among numerous NGOs, church groups, community activists - in the fight against the virus.

Although Ugandan experience could provide invaluable information to other nations in their prevention efforts, he said, "inappropriate recommendations based on poor interpretations of evidence must not be used as the basis for policy".

These claims have sparked a row in Uganda, with officials vehemently denying them. Minister of State for Health, Mike Mukula, and Minister of State for General Duties in the Prime Minister's Office Mondo Kagonyera told parliament on Wednesday that there was no reason to doubt the president's figures, because they were the result of scientific research, The New Vision reported.

Director-General of Health Services Francis Omaswa assured the public that the data were valid and reliable, according to The New Vision. The data were "generated using internationally accepted methods by a wide range of independent partners of high calibre".

"They don't believe that any country in Africa can do anything positive," the health minister was quoted by the same newspaper as saying.

But Parkhurst insists that "the standards of proof for policy recommendations seem to have been lowered to provide the international community with the African success story it wanted, or even needs". Parkhurst suggested that pressure to produce results may have resulted from "donor fatigue" - a lack of willingness to fund unsuccessful projects - combined with an overall reduction in funding available to Africa. Similarly, he noted, low morale among health workers could be boosted by a success story.