History of the epidemic

AIDS Policy Debate
History of the epidemic, see how U.S. AIDS spending priorities have changed.
Uganda have promoted a traditional message of celebrating virginity at marriage, encouraging young people to be abstinent until marriage and then asking those who are married to be faithful to their partners, with little emphasis on condom promotion (what has become known as their ABC message). They have had some success in highly targeted condom campaigns, and no documented success in broader condom campaigns. America needs to become known as the biggest promoter of the A and B of ABC, not known as we are now as the biggest provider of C.Uganda's message contrasts sharply with the messages given out in the southern part of Africa. There the dominant and primary message has been the promotion of condoms. We saw this in the early '90s and were surprised to see an even greater emphasis on our return trip last year. Very few government funded programs focus on abstinence or faithfulness, and certainly most US sponsored programs, whether government or private, focus on the broad social marketing of condoms. There is some emphasis on diagnosis, but even that is often anonymous in nature.We should remember that the biggest predictor of any sexually transmitted disease is the number of lifetime partners; the more partners the more risk, fewer partners less risk, and one uninfected partner in a faithful relationship virtually no risk. The President has it right, Uganda can teach us many important lessons."



"No less than twelve U.S. government-funded evaluations at the state level have shown that U.S.-based abstinence-only programs have little influence on participants' sexual behavior and may cause harm by discouraging the use of contraception. Additional studies have suggested that "virginity pledges," a staple of abstinence-only programs in which young people promise to abstain until marriage, often fail and may result in lower contraceptive use (and higher STD rates) among sexually active unmarried youth.
Officials in both the U.S. and Ugandan governments have ignored these studies. Instead, they have misleadingly used national survey data to suggest that abstinence and fidelity are more popular among Ugandans than condom use. Not only do such data provide a poor substitute for evaluation of abstinence programs, but research in Uganda clearly indicates that a comprehensive approach to HIV prevention—one emphasizing positive behavior change, high-level political leadership, condom use, widespread HIV testing, and a myriad other factors—is what allowed the country to reduce HIV prevalence in the 1990s.


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Nothing in the demographic or historical record suggests that "abstinence education" as conceived by the United States is what contributed to Uganda's HIV prevention success."wo years ago the Alan Guttmacher Institute published an article full of praise for Uganda's "ABC approach" to HIV/AIDS prevention — Abstain, Be faithful, use Condoms:Between the late 1980s and mid-1990s, at a time when HIV/AIDS was well on its way toward ravaging Sub-Saharan Africa, Uganda achieved an extraordinary feat: It stopped the spread of HIV/AIDS in its tracks and saw the nation's rate of infection plummet. As word of the "Uganda miracle" spread, journalists, researchers, policy-makers and advocates all descended to try to ascertain how it was accomplished.In September, 2005, THE ECONOMIST published an article on Uganda and AIDS with quite a different tone:AIDS has killed about 1 [million] Ugandans, while some 1.1m may still be infected with HIV—big figures in a population of 27m. But by African standards, alas, they are something of a success story. Much of the credit has gone to Yoweri Museveni, president since 1986. But now the campaign against AIDS is faltering amid accusations of moralistic grandstanding and financial mismanagement.What has changed? Some critics point to an aspect of President Bush's Emergency Plan for AIDS Relief (PEPFAR), and its emphasis on "abstinence-only" programs. Others say that the A in ABC has long been the key to Uganda's success in fighting AIDS. NOW's visit to Uganda.


In "Global Health: America's Response" examines the U.S.'s HIV/AIDS policy from its beginning in the early 1980s through President Bush's historic plan, announced in 2003, to spend $15 billion for treatment and prevention of HIV/AIDS around the world. The one-hour documentary takes viewers on the ground in Uganda to examine how Uganda's successful three-pronged approach, which has become known as ABC: "Abstinence," "Be faithful," and "Condom use," has sparked controversy among both American and Ugandan groups which don't believe condoms are effective in reducing HIV prevalence and that they contribute to promiscuity. Buoyed by the fact that at least 33% of U.S. money in President Bush's plan set aside for prevention must go to groups that promote so-called "abstinence-only" programs, which downplay or ignore the importance of condoms in HIV prevention.

D. Walker, an acclaimed AIDS specialist at Massachusetts General Hospital, didn't really want to go to South Africa. He was engrossed in his laboratory's AIDS research in Boston, and a trip to see his team's field work seemed a risky distraction.

But just when the American AIDS epidemic was fading from the headlines, the disease was exploding with a vengeance in the late 1990s in South Africa, and nowhere more savagely than in the teeming Indian Ocean city of Durban and the surrounding villages in the green hills of KwaZulu-Natal Province. About 60 percent of pregnant women coming to clinics in and around Durban were infected with HIV, and one-third of their babies were born with the virus.

In early 2001, Walker traveled to Durban to see for himself. The trip set in motion a chain of ever-deepening involvement for Walker and his AIDS research team at MGH in the worst killing fields of the global AIDS pandemic. That work has transformed his career, and touched many lives in Boston as well as South Africa. And now the South African link has helped thrust Walker and his Boston laboratory into a leading role in the global hunt for an AIDS vaccine.



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Walker helped turn a ramshackle lab at Durban's medical school into a state-of-the-art research facility. He organized and encouraged pilot treatment and training programs in South Africa by MGH doctors, going far beyond pure research at a time when South Africa's government was denying the causes of the AIDS catastrophe. He helped raise tens of millions from American funders to support innovative projects. And he helped the South African government devise its belated nationwide rollout of antiretroviral drugs.

Walker's South African work also connected him with Phillip Terrence Ragon, a Cambridge high-tech tycoon whose company sold software there. The two visited Durban in early 2007 - and Ragon was as excited by the immense possibilities as he was shocked by the suffering he saw.

This month, Ragon and his wife, Susan, pledged $100 million to create a new institute to develop an AIDS vaccine. The Ragon Institute will draw in scientists from MGH, Harvard, and the Massachusetts Institute of Technology, with Walker at the helm.

Ragon was just one of a long line of potential benefactors who had traipsed to Durban with Walker on what colleagues dubbed "the Bruce Walker tour."

On his first trip in 2001, Walker brought along Elaine K. Gallin, head of the medical research program for the Doris Duke Charitable Foundation. They tramped through city hospital wards overflowing with AIDS patients, and visited the decrepit lab at the Nelson Mandela Medical School at the provincial university where the MGH field team was borrowing space. A blacks-only school during the apartheid era, the medical campus had not had a single new building in more than 50 years.Continued...