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.¹ 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 may even be growing more severe,² for many people life in Uganda has been better in recent years than it has been for more than a generation.

Between independence in 1962 and Museveni’s takeover in 1986, more than a million Ugandans were murdered in political violence and millions more died of starvation and disease. In What Is Africa’s Problem?,³ a collection of his speeches, Museveni describes how, in the early 1980s, packs of soldiers roamed from village to village, raping women and bashing the heads of crying babies. In Luwero district, where some of the most brutal fighting took place, skulls were heaped up in the forest. By 1986, most of the country’s roads, hospitals, and cities were in ruins and consistent supplies of water and electricity were available almost nowhere.

The economy was run largely by thieves. Idi Amin, who overthrew Milton Obote and took power in 1971, appropriated much of the private capital in the country, including factories and shops, and these were soon destroyed. Uganda’s only export was coffee beans, which were produced by rural farmers and then sold through government-owned companies. The foreign exchange earned through these companies was not used to develop the country but to import whiskey and transistor radios to bribe and placate the army. In the cattle-herding regions of the north, wealthy raiders used helicopters to locate cattle to steal. In the south, along the Tanzanian border, black-market traders got rich smuggling coffee out of the country and importing such essential goods as food and soap at highly inflated prices. Between 1970 and 1985, per capita GDP fell by half.

In 1995, the Kampala skyline still consisted of concrete buildings riddled with bullet holes and streaked with filth, church steeples, minarets, and construction cranes that, I was told, had not moved in more than a decade. There were building lots filled with rubble and piles of rotting banana peels, fed upon by giant marabou storks, scavengers with wings like black shrouds and bald, pink gullets shaped like the trap under a sink. These creatures were rarely seen in Kampala until the mid-1980s, when they came to feed on the detritus left behind by twenty-five years of corruption and war.

Kampala has changed considerably since then. When I visited Uganda again in April 2001, I could see the entire city in its green basin from my hotel window. Mist from cooking fires hung over the slums, and a giant gray cloud sat on the rim of the surrounding hills. Once-derelict streets are lined with freshly painted shops and new hotels and glass office buildings had risen in the center of town. The paralyzed cranes were gone.

Perhaps Uganda’s most noted success during the past decade has been its management of the AIDS epidemic. By the early 1990s, President Museveni became the first African leader to declare AIDS an economic and social catastrophe; a little reluctantly, because in public he is a puritanical man, he acknowledged that people should use condoms to protect themselves. He invited Western charities to establish prevention campaigns and Western researchers to study the epidemic. Condoms are available in most places, and there are radio programs that describe, in precise, even tedious, detail, how to use them. Surveys show that most Ugandans know what HIV is and what they should do to avoid it.

These efforts have been reasonably successful. In 1992, 16 percent of all adults in the country were HIV-positive, but by 1996, only 8 percent were. The proportion of HIV-positive people in Uganda has fallen far more slowly since 1996, and there were even indications that the infection rates rose slightly in rural areas in 1999.^[4]But even if the decline in HIV prevalence has slowed, Uganda’s relative success in dealing with HIV is unique in sub-Saharan Africa, and international health experts from the UN and other agencies have claimed that Uganda should be seen as a model for other countries.

However, questions have been raised about whether the fall in the number of HIV-positive people in Uganda really indicates that the epidemic is waning. To understand this, it helps to know the difference between what epidemiologists call “prevalence” and “incidence.” Prevalence refers to the number of infected people in a population, while incidence refers to the rate at which people become infected. In an epidemic, it is incidence that must be reduced. Prevalence falls later, as people either recover or, in the case of HIV, die from AIDS. Incidence is much harder to measure than prevalence, and health departments seldom do it routinely. But epidemiologists conducting smaller studies of particular Ugandan populations have shown that even when prevalence is falling, incidence may still be high, or even rising. In fact, while some regions of Uganda have seen a fall in HIV incidence during the 1990s, others have seen little change.⁵

The Ugandan HIV epidemic probably occurred in two phases, and this could explain why incidence may be stable or even rising, even though prevalence is falling. The first phase occurred during the war and its aftermath in the 1980s. At the time, many cases of HIV infection probably resulted from what the authors of a recent study politely refer to as “one-off” sexual encounters.⁶ Rape and prostitution, in particular, are well known to escalate during war. For example, it is estimated that virtually every woman who survived the Rwandan genocide was raped; at least 20,000 women were raped during the Bosnian war; and at least 250,000 were raped during the 1971 war of independence in Bangladesh. I could find no statistics on rape in Uganda during the civil war in the 1980s, but it is believed to have been very common.

At the time, Ugandan women also saw their families and livelihoods destroyed, and some were forced to exchange sexual favors to provide basic needs for themselves and their children. Since HIV prevalence rates among soldiers in East Africa tend to be very high, it is plausible that HIV first began to spread quickly in Uganda during the turbulent early 1980s. The second phase of the HIV epidemic in Uganda occurred during the relative peace of the 1990s. Today, most HIV transmission actually takes place in longer-term relationships. Indeed, those most at risk of HIV infection in Uganda now are married women who have sex only with their husbands.

The hypothesis that the HIV epidemic in Uganda occurred in two phases implies that HIV prevalence may have fallen in the 1990s because many people infected during the war in the 1980s died of AIDS. Nevertheless, HIV incidence rates during peacetime may still be quite high, although they are probably much lower than they were during the war.

2.

For more than a decade, charities and health ministries in many sub-Saharan African countries have established numerous HIV prevention programs like those in Uganda, but the results have been mixed. HIV prevention programs in Africa have been far less successful than those for gay men in Europe and the United States, and there has been much speculation about why.⁷ Some programs have been moderately successful, but the epidemic is far from over anywhere in East and Southern Africa, including in Uganda.

When I was in Uganda in 1995, I myself wondered about the effectiveness of prevention programs. By then, it seemed clear that the vaccine I was studying did not work, and I knew it would be a decade, at the very least, before scientists found one that would protect people from HIV. But Uganda could not wait for a vaccine. At the time, one in five adults in Kampala was HIV-positive, and the virus was spreading along trade routes into the countryside and up into the poor and isolated villages in the north. The AIDS epidemic has concentrated attention on the circumstances in people’s lives that increase the likelihood of unsafe sex, even when people know they should be careful. These circumstances are still poorly understood, but at least two schools of thought have emerged. Either people’s beliefs about condoms, fertility, and disease prevent them from practicing safe sex or they are constrained by larger social conditions in their lives, such as poverty and unemployment, that result in a kind of resignation, a feeling that HIV infection is inevitable, and beyond one’s power to prevent.⁸

Every African community has a medicine man or woman to whom an estimated 80 percent of African people turn in distress. These healers are part quack doctor, part psychiatrist, and through their rituals, stories, and medicine they preserve and hand down traditional African culture and beliefs. Perhaps it is through these healers, I thought, that I could understand the mysterious, persistent spread of HIV.

I knew of a charity that was working to train Ugandan traditional healers to become AIDS prevention counselors and I spent a few months working with them, tramping through villages and riding on bicycle taxis into the Ugandan countryside. I met a healer who cured his patients of diseases of the mind and body by placing live chickens on their heads, and another who did it by massaging the soles of their feet. Yet another inspected drops of his patients’ saliva on the surface of a mirror. For many healers, the cure was the sacrifice of a white chicken or, in more serious cases, a goat. The healers told me how the human race had been created when the sun and the moon gave birth to the stars, and then to the earth and the gods. There were gods for love, jealousy, and malaria, but there was no god for AIDS. All of the healers knew about AIDS, but they said they didn’t know where it came from, or how it could be cured. Many of them went to the training sessions the charity conducted, and learned to demonstrate how condoms are worn, and how to recognize when a patient probably has AIDS and should go to the hospital.

Once I went to the initiation ceremony of a traditional healer named Matthew. About thirty people gathered in an old barn in a village near Kampala. The ceremony lasted until dawn, and during the night different men and women fell one by one into mystical trances in which they reenacted the founding myths of the Buganda people, the largest tribe in the country.

During the daytime, Matthew was an accountant for an auto repair shop in Kampala, or he would have been if the company’s owner had not emptied its bank account and gone to Kenya. Matthew still sat in his office all day reading newspapers and waiting for people to ask him to do their accounts. On the street where Matthew worked you could buy almost anything: furniture, chicken coops, spare parts for cars, machine tools, jerry-built appliances of all kinds. Pale green trucks with flimsy sheet-metal frames stood in the middle of the street piled high with bananas, foam rubber mattresses, chickens crammed in their cages, their feathers raining everywhere. The businesses spilled onto the sidewalk of broken paving stones, where women with enormous bundles on their heads and dusty, barefoot workers dressed in rags and stray goats and chickens mingled with the chaotic traffic in the street.

Matthew and I had an appointment, but he was not around. The workmen in the shop next door said that they had not seen him all week. A few days later, I came to look for Matthew again, and found him slumped in a chair, asleep. I startled him when I walked in, and he apologized for not showing up for our appointment. He was sorry, but there were problems at home. A girl had been raped, his niece. I had met her, she was the tall, shy one who had kneeled down when she brought me a cup of tea. She was all right, he said, bleeding a little. His wife, who was also a healer, had treated her with some traditional herbs. It happened at night, and Matthew knew who had done it, a man of about twenty who lived nearby.

In order to press charges, Matthew needed a document that had been signed by the local police commander requesting that the girl be examined by the police surgeon. Matthew had taken the girl to the police station, but when they got there, they had been asked to wait. He and the girl waited all afternoon. They were eventually told that the commander would not have time to see them that day.

The next day, Matthew went to the police station with the local government official. The police chief now had time to see them. He said, “Gentlemen, we have a problem in Uganda.” The government had not paid the police surgeon, so what could they do? The police surgeon could not work without money. The form for the report would cost 50,000 shillings. Matthew refused to pay. He said he would call a lawyer. Rape was a serious crime.

I asked Matthew if he needed any help. I knew about a group of tough women lawyers in town who might take the case. No, Matthew said. He knew what to do.

The following week, I came to see Matthew again, and this time he was in better spirits. The situation has changed, he said. The mother of the boy came and prayed to us. She was worried. You know, the penalty for rape in this country is death.⁹ The police would shoot her son if they caught him. His niece was OK. She had gone back to her father’s village, about fifty miles away. She was not hurt so badly. He thought the hymen was already broken.

I wondered, but didn’t ask, how much Matthew had been paid by the rapist’s family. Fifty dollars? A hundred? Matthew was following traditional Ugandan law, according to which a woman is the property of her family. A woman’s rights belong to her male relatives, so in cases of rape a woman cannot be wronged, but they can demand compensation. In many African countries, the crime of rape has only recently begun to be taken seriously. Now, because of the AIDS epidemic, rape and other forms of sexual coercion and abuse are drawing increasing attention from lawyers, researchers, and women’s groups. The findings are alarming.

According to the UN, around 40 percent of Ugandan women have experienced some form of sexual violence in their lives, and the situation is probably similar throughout East Africa, and worse in Southern Africa. This includes rape and coercion by husbands and boyfriends, as well as strangers. There are indications that sexual violence contributes enormously to the HIV epidemic. Recent studies from Tanzania and Uganda have found that young women who are HIV-positive, whether married or not, are seven to ten times more likely to have been beaten up or raped or otherwise coerced into sex in the past year, compared to women who are HIV-negative.¹⁰ For epidemiologists, an increased risk of seven- to tenfold is very significant, like an archaeologist’s “key find,” the artifact that just might explain everything else.

Poor women in Africa often have very little control over their reproductive lives. How many children they have, and when to have them, and whether to have sex with a condom: these are decisions in which many poor African women have very little say. The long continuum between actual rape and the kind of persistent intimidation that makes women afraid to raise the issue of condoms with husbands they know are philandering contributes to a general climate of powerlessness. Police corruption and the weakness and poverty of justice systems (both exacerbated by World Bank–mandated cuts in public sector salaries and spending) only reinforce a prevailing disregard for women’s rights and feelings.

It is not known why violence against women is more common in some societies than in others. In World Mental Health,¹¹ the anthropologist Robert Desjarlais and colleagues speculate that recent civil conflicts in developing countries may have more long-lasting effects on social life than the European wars of the early twentieth century did, because the nature of war has changed. The object of so many recent conflicts has been the control of populations, rather than territory, so civilians are not just bystanders but often targets of violence. During the two World Wars, the majority of casualties were soldiers, but during the wars of the past forty years, most casualties have been civilians, some of whom have died in particularly grotesque ways. When combatants cut off the heads of their victims and place them on stakes, or rape all the women in a village, the aim is not just to kill the enemy but to demoralize him. Such conflicts may particularly fuel men’s rage by challenging their self-respect. At the same time, such conflicts destroy the very social ties that normally help prevent abuse of women.

It is difficult to make connections between larger social conditions and the personal behavior of individual men and women. But it is striking that in so many places where political violence has ended, apparently random acts of violent crime, particularly against women, continue and even increase. Writers have described how in Cambodia, Mozambique, Uganda, and El Salvador rape, domestic abuse, and intimidation of women are a feature not only of war itself, but of its aftermath as well.¹² In South Africa, while the political violence has died down, rape and other forms of violence have become a part of everyday life. An adolescent girl from Gauteng province recently told an interviewer, “They find you on the street and they force you to go home with them so that they can have sex with you. It is rape, but we don’t call it rape because they are our boyfriends.”¹³

The authors of World Mental Health ask, “To what extent does domestic and street violence result from prolonged repression and conflict?” At the moment, they conclude, we don’t know, nor do we know to what extent abuse of women is related to what the authors call “structural violence,” which includes poverty, migrancy, inferior education, and other extreme forms of disadvantage.¹⁴

The causes of the African AIDS epidemic are complex, and sexual violence is not the entire explanation. Certainly not all African men abuse women. Far from it. Nor are all cases of HIV infection in the region to date likely to be the result of forced sex. But abuse of women by poor, frustrated, angry men has been a factor in making HIV as widespread as it is. Once HIV begins to spread in the general, heterosexual population, all such relationships become much riskier. In other words, violence against women might have been the spark that set off the blaze. Furthermore, as more people learn about how to protect themselves from HIV, those who remain most vulnerable to infection will likely be those who suffer most from injustice, anger, and abuse. For these reasons, the results of prevention programs may continue to be disappointing, unless the rights of women are strengthened at the same time, and unless sub-Saharan African countries can provide young men with an alternative to poverty and hopelessness.

3.

What is the future of AIDS in Uganda? The answer may well depend on whether the country remains at peace. But all was not well when I returned there in April. Since 1996, Uganda’s army has been fighting various factions in the Congo war, first the Hutus who fled from Rwanda after the genocide in 1994, and then the government of Laurent Kabila and his supporters from Zimbabwe, Namibia, and Angola, and now the army of Rwanda, which, confusingly, was until recently Uganda’s ally. The war has been a drain on Uganda’s economy, and has increased tensions among the nation’s many ethnic groups. In April, the UN released a report accusing high-level Ugandan army officers, including Museveni’s brother, Salim Saleh, of systematically looting gold, diamonds, timber, coffee, livestock, elephant tusks, automobiles, and private property, exporting them from the Congo to Uganda, and then reselling them through his own companies to buyers all over the world who have chosen not to ask questions about where the goods come from. Some of these goods were allegedly stolen, and some allegedly bought with counterfeit Congolese francs and US dollars.¹⁵

Salim Saleh has also been involved in several dubious privatization deals, in which state-owned companies and banks were sold off for far less than they were worth to companies he owns. In one disturbing account,¹⁶ businessmen who attempted to buy a government-owned hotel said they were threatened with death because they refused to pay a bribe to Museveni’s brother. Smuggling and extortion are hardly unknown in Africa, but in Uganda it is creating a tiny, corrupt wealthy class with very close ties to the President, and this seems all too familiar to those who recall the country’s terrible past.

In March 2001, Uganda held presidential elections. There were six candidates, one of whom, a medical doctor and retired colonel from Museveni’s National Resistance Army, was a serious challenger to Museveni. Kizza Besigye fought alongside Museveni during the war in the 1980s, and later joined his government. He decided to run against Museveni because he believed the President had been in power for too long, and had become complacent and corrupt. Besigye has been critical of Uganda’s involvement in the Congo, and of increasing human rights abuses within Uganda itself. He also supports multiparty democracy, while Museveni believes the country should remain in the hands of his own National Resistance Movement. During the months leading up to the election, there were numerous episodes of violence, kidnapping, and torture.¹⁷ By far, most offenses, according to newspaper reports, and according to Human Rights Watch,¹⁸ were carried out by Museveni supporters, including Museveni’s personal guards, the Presidential Protection Unit, against Besigye supporters. Besigye challenged the election results in court, alleging that two and a half million ghost votes had been cast in Museveni’s favor. The Supreme Court decided, by a vote of 3–2, not to annul the elections, and Museveni was recently sworn in to another presidential term.

It is widely believed, however, that the Court had originally decided that the elections had not been legitimate, but that the evening before the ruling, Museveni threatened the judges that he would call in the army if they did not revise their decision.¹⁹ Besigye has decided not to challenge the election results again, and, despite the fact that the election was clearly flawed, this is good news for Uganda. If he did, the pre-election violence might well escalate into yet another civil war. In that case, it seems clear, no HIV prevention program could prevent another surge in infection rates.

4.

AIDS threatens African development because it kills and disables adults of working age and leaves children without parents. Societies lose teachers, doctors, bureaucrats, soldiers, businessmen, and other workers, and the rest of the world loses consumers. But AIDS is as much a symptom of social crises as it is a cause of them. Rural poverty, corruption, political mischief, human rights abuses, and a pointless war are reviving tensions that linger from Uganda’s brutal past and could contribute to further spread of HIV. There are already signs of increased insecurity. Kampala is still one of the safest cities in Africa, but there are reports that violent crime rates have risen in recent years, after a long decline since 1986, and I heard people talk casually about crime in a way they did not before. During the past few years, Kampala has been hit by a spate of bomb attacks and eight students at Makerere University have been murdered, but the killer has never been found. There are stories in the newspaper about traditional healers kidnapping and sacrificing children, because chickens and goats no longer do the trick. There are also many accounts of domestic violence, which remains an endemic problem.

Recently the UN, a group of concerned Harvard academics, and other advocacy groups have been campaigning for an AIDS fund for developing countries that, they hope, will amount to up to $10 billion per year. There is considerable debate about how this money should be spent, if it actually materializes. Lack of AIDS treatment and inadequate funding for prevention programs in Africa are increasingly seen as grave injustices. However, injustice itself, and the many forms it takes in Africa, are a fundamental cause of the growth of the epidemic, and unless that changes, even the most well designed prevention programs may not make much headway.

In the meantime, thousands of Ugandans are dying every year from AIDS, and there is a desperate need for better treatment. But that is not all they need. In April I accompanied a nurse from the charity Hospice Uganda on a visit to a woman who was dying at home, in a village outside of Kampala. In the small, dark room, the patient’s skeletal outline was barely perceptible among the wrinkles in the bedcovers. Sun shone through holes in the iron roof, so that the patient got soaked when it rained. “We would fix it if we had the money,” the woman’s sister said. Family members gathered in the room and asked the nurse questions as she dispensed antibiotics and painkillers. Small children came and went, and one little girl, about four years old, with a bald head and tiny shoulders, stared at me. This was the patient’s daughter. Her uncle, a man of about twenty, leaned over and asked me a question: “The other children go to school, but not this one. She keeps getting sick. What do you think is the matter with her?” I did not have the courage to tell him what he already knew.

There is much explicit information in the newspapers and on the radio in Uganda about how to use a condom, and the feelings, manners, and techniques of romance and sex; but there is far less open discussion about what it is really like to live in a family affected by HIV. There is an odd silence surrounding these people, who now number in the millions, if you include those whose wives, husbands, parents, siblings, or children are HIV-positive.

The family I visited was relatively lucky. The nurse comes once a week. But Uganda needs much better salaries for more people like her, and also for better medications and health centers for the roughly 50 percent of its people who have no access to health care at all.

While I was in Uganda, I learned that these people also need not just health care, but protection from cruel and discriminatory treatment as well. I met a woman named Milly Katana, who runs an organization that monitors AIDS-related discrimination. She explained to me how, in the early days of the epidemic, people used to gossip whenever someone died. People didn’t want to sit next to someone whose children or husband was known to be sick, and schoolchildren would tease classmates whose parents had died. At funerals, rumors would go around: “If that one died, well, so-and-so is next.” But according to Katana, Ugandan communities soon realized that anyone could die from AIDS, and these cruel attitudes are slowly changing. Now, she says, a new form of discrimination is emerging, in businesses, the civil service, and other institutions. President Museveni has made a negative HIV test a requirement for promotion in the army, and the US embassy had a similar policy, but it ceased this month, after journalists accompanying Colin Powell on his recent African tour drew attention to it.

Being HIV-negative is also an unspoken criterion for employment in many businesses. During the past ten years, under Uganda’s World Bank– sponsored reform program, state-owned businesses have been privatized and government jobs have been cut. As a result, many workers and civil servants have been laid off. According to Katana, workers whose wives, husbands, or children have died, and who are therefore suspected to be HIV-positive—what her HIV activist friends call “the so-called sick”—are usually the first to go.

People may live with HIV for years or even decades without AIDS symptoms, and human rights groups have long argued that HIV infection should be treated like any other “latent” affliction, such as diabetes or high blood pressure. Uganda has no laws against unfair hiring practices based on HIV status, but they are in clear violation of international guidelines established by the UN Commission on Human Rights.²⁰

Before I met Katana, I attended a speech given by President Museveni on the subject of AIDS. Museveni is a large man, with a great bald head like polished brass, and a deep voice that carries very far, like the roar of a lion. In his speech, he told a rather strange story, tracing the origins of the AIDS epidemic in Uganda to the arrival of Europeans in the nineteenth century. Before that, Ugandan society had strict moral codes. For example, if an unmarried girl became pregnant, “the punishment then for the boy and girl was death; the girl would be tied in dry banana leaves, set on fire, and rolled down a cliff, and the boy speared. But when the Europeans and Christians came they said it was barbaric, and put a stop to it. So the tribal regime broke down into a permissive society.”

Press reports provide further insights into the President’s attitude toward people with HIV. For more than a decade, rebels based in Sudan have launched attacks on villages and towns in northern Uganda. More recently they have been abducting Ugandan children and forcing them to join their armies, or in the case of girls, to work as slaves. The parents of 12,000 of these children have been complaining that the Ugandan government has not been doing enough to get their children back. Museveni has responded by saying that these children were by now HIV-positive anyway, so they were “no longer an issue.”²¹

Shortly before polling day in March 2001, Museveni told an American journalist that his main opponent, Kizza Besigye, had AIDS.²² Later he repeated his remarks to the Ugandan press. “State House is not a place for invalids,” Museveni said. In the court case challenging the election results, Besigye denied that he had AIDS, and claimed that Museveni was spreading false rumors to dissuade voters from supporting him. But Museveni’s lawyers argued that since Besigye’s first wife and child had died in the early 1990s, it was fair to assume that he had AIDS. AIDS support groups in Uganda have claimed that Museveni’s statements were an outrageous and cynical attempt to use the stigma surrounding HIV to further his campaign, and to promote discrimination against people whose lives have been affected by AIDS.

In Uganda, the loyalty and strength of Ugandan families and the perseverance of HIV prevention workers and AIDS treatment advocates are continually undermined by war, corruption, and injustice. HIV struck Europe and the US just as gay men were organizing to confront discrimination against them, and the struggle against AIDS became part of the greater struggle for gay rights. By and large, the people of sub-Saharan Africa have yet to assume their rights. Until the status of women improves, something that is linked to the improvement of rights for all people, regardless of tribe, political connections, or HIV status, the most generous funding for AIDS in Africa will not go nearly far enough.

—June 6, 2001