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PART II : Main Sources for HIV/AIDS Information, Main Channels of Transmission, and Attitudes Toward Condom Use
Main Channel(s) of HIV Transmission
In 1998, an STD/HIV surveillance report was conducted and it was determined that the main routes of HIV transmission in Uganda are:
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Heterosexual contact with an infected partner accounting for 75-80% of new infections;
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Infected mother-to-child transmission accounting for 18-22%;
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Use of infected blood and productions accounting for less than 2% of HIV infection as of 1991; and
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Sharing non-sterile sharp-piercing instruments with an HIV infected person accounting for less than 1%.
Heterosexual transmission is the most prevalent cause of HIV/AIDS transmission. For example, rampant throughout particular areas found in Uganda are commercial sex workers. Prostitutes and prostitution clearly constitute a reservoir of infection; thus accounting for a significant factor in the spread of HIV/AIDS within Uganda. Women succumb to commercial and casual sex to acquire some means of income; the willingness and cheap prices appeals to customers, which contributes to the widespread practice. Often, this trade is the only option available for women with very little or no education. Also established truck-stops on main highways have been shown to have considerably high HIV-prevalences in the general population than communities in surrounding rural areas. Thus implicating that truck-stops, where a majority of commercial sex acts take place, foster the ideal environment for the spread of HIV/AIDS; moreover contributing tremendously to the growing epidemic in Uganda.
In addition, there has been a growing body of evidence supporting the spread of HIV/AIDS owing to unsafe sexual behavior in Ugandas youth. Factors that promote or perpetuate unsafe sexual behavior include:
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Knowledge and Beliefs
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-young people know that AIDS is a fatal, and a sexually transmitted disease, but their knowledge about HIV and its mechanisms of transmission and method of prevention are very low
-there is no certainty about the proper use of condoms and their purpose
-many youth underestimate their risk for contracting HIV |
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Coercive, Male-dominated Sexual Relationships |
-sexual negotiation of any kind, including condom use, faithfulness, or the nature and frequency of sexual intercourse, is lacking in many relationships among youth |
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The Physical and Organizational Environment |
-lack of access to condoms
-low access to media (one of the main sources of HIV/AIDS education)
-living on the streets promotes and fosters environment for prostitution (for both boys and girls) |
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Culture |
-coercive sexual relationships (patriarchal and oppressive toward women)
-socio-economic status
-(male) belief that using a condom diminishes masculinity
*HOWEVER, it should be noted that these are not beliefs taken by all Ugandan youth. For example, the more religious one is, the more likely one postpones sexual activity, have fewer partners, allow women to have rights, SISSY this last point, I think you should take it out I dont think religion implies this, but if you have a footnote where you got this leave it in and footnote it |
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Poverty |
-may be the most significant vector for HIV/AIDS spread among young
-usually reason for commoditization of sex |
Undoubtedly, cultural practices also contribute to the increasing spread of HIV/AIDS. Practices such as polygamous marriages promote promiscuity, increasing the risk for transmission. Men are inherently polygamous and it is their normal state to have more than one wife. Age of first sexual contact is also a factor to consider when examining the prevalence of HIV/AIDS in Uganda. Girls especially, are introduced to sexual intercourse at a young age due predominantly to economic reasons. Perhaps a dowry payment cannot be made, and the girl is then forced to participate in commercial or favor sex. These are a few cultural practices on Uganda that largely contribute to this killers success.
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Main Sources for HIV/AIDS Information
An important aspect of decreasing and ultimately defeating the HIV/AIDS epidemic in Uganda is education. Where do the citizens of Uganda acquire information regarding prevention, treatment, causes, etc.? Traditionally, acquired knowledge was to be ceded to the home of the girls paternal aunt (Ssenga) for a period of time preferably preceding her menarche. For instance, the Ssengas primary role was to initiate the elongation of the labia; a traditional ritual preformed on girls reaching the age between 10-15. Elongation of the labia primarily served the purpose of stimulating the man. Overtime, this practice has changed and information about sexuality, including HIV/AIDS, is no longer passed via the Ssenga. Peers, both in the neighborhood and in schools were beginning to replace the paternal aunts as the source of information pertaining to sexuality.
Since the onset of HIV/AIDS in Uganda, initiatives have been made to increase education and awareness about HIV/AIDS. These initiatives have been implemented in schools, via newspapers, national and international organizations, counseling, medical, and home care support services, and especially through Ugandas evolving government.
Commonly found in schools across Uganda are education programs on condom use. Schools provide an opportunity for open discussion about condoms, including education on how to properly use condoms and the advantages of reducing HIV transmission. Safer sex promotions are increasing being advocated by schools. Newspapers also served to be a great source of HIV/AIDS information. They provide a medium for citizens to express questions about HIV/AIDS, which are in fact taboo due to cultural values that discourage open discussion of sexual behavior. Thus, many questions remain unasked, especially among the public. Transmission, HIV testing, symptoms and diagnosis, and stigma and myth are among several questions asked by the population.
Additionally, national and international organizations such as UNAIDS, Uganda AIDS Commission (established in 1992 specifically to foster the implementation of the governments Multi-sectoral Approach to the Control of AIDS [MACA]), are only a few of many major organizations that have aided in the decimation of the epidemic.
HIV counseling and testing (HIV CT), particularly in rural Uganda, plays an important role in not only educating the public about HIV/AIDS, but also aids in assessing views about HIV CT among the people. Participants of the programme strongly express the need for HIV CT services; it was noted, however, that some groups in Uganda were not able to receive services because the nearest testing center was 65 km away. Various reasons as to why HIV CT is useful include: better knowledge about HIV/AIDS, better understanding of HIV/AIDS in the community, less stigmatization of persons with HIV/AIDS. Thus there is a positive response from the public to HIV CT; albeit many participants still feel that there are too few HIV-testing and counseling sessions provided to change sexual behaviour towards safer sex methods.
In addition to obtaining views on HIV CT, supplementary information on HIV/AIDS was also gathered. For example, premarital sex relations are widely practiced among youth; this, also, however, involves married persons having sex with unmarried boys and girls. The prevalence of extra-marital relations is in large part due to poor economic status. For instance, young girls use sex as a means of achieving what they would otherwise not be able to afford.
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Attitudes Toward Condom Use
It is evident that the spread of HIV/AIDS in Uganda presents a tremendous peril to its citizens, subjecting them to latent risk of transmission. As the increase of HIV/AIDS continues to rise, recognition and prevention are not far behind. It is only recently that condom education has been introduced into school programming, targeting Ugandas youth in attempts to decrease HIV/AIDS numbers.
Trends pertaining to awareness, acceptance, and use of condoms have generally been consistent, and steadily increasing. An open government policy, widespread public awareness campaigns, and aggressive social marketing stand behind the change. Because the introduction of condom education into school programming is fairly new, condom education is rarely provided in Ugandan schools; albeit, both boys and girls had relatively high overall levels of knowledge about condoms. This suggests that the youth are obtaining information from other sources such as the media, radio, television, public advertisements, family members, and the like.
As condom awareness in Uganda increases, young people still face barriers if they want to learn about condoms. It was noted by Twa-Twa (1997) that in Uganda, condom use and education promotion among school students is constrained by traditional cultures and religion. However, disparate resistance from a variety of sources advocates the inclusion of condoms in a school-based AIDS education programme. Such sources advocating the inclusion of condoms include: parents, religious groups, school administration, and especially the teachers who implement the programme themselves. Targeting Ugandas youth is among the many emerging aspects of HIV/AIDS prevention strategies that are being introduced and implemented in Uganda.
Widely held by Ugandans are the benefits of the male condom and alternative uses such as the female condom, which have also been recently introduced into HIV/AIDS education and prevention in Uganda. Both men and women testify that its consistent and correct use makes it highly effective in both disease prevention, and as a contraceptive method. Condom usage, however, is not universal and can be inconsistent; this is evident in womens and mens attitudes toward the use of condoms. Here I provide a summary of prevalent attitudes that men and women hold about condom use:
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WOMENS ATTITUDES |
MENS ATTITUDES |
COMMON ATTITTUDES |
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MALE CONDOM |
-its use is in the control of men
-condoms are impregnated with HIV- virus during manufacture
-men might remove the condom during intercourse in order to infect their partner |
-could protect against unwanted pregnancy
-less sensation during intercourse
-want to use condom but prevented by their partners |
-widely held belief that male condoms are life threatening that is to say, the condom can slip off the penis, pass through the cervix and become lodged in the uterus
- condom is porous and could let HIV-virus through
-practical and easy to use
-deliberate attempt to put holes in them in order to infect their partner |
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FEMALE CONDOM |
-seen to have advantage over male condom; women could consistently use it
-easy to hide at home and in the body
-some women are unsure if the female condom is really protective |
-seen as good because they gave women the means to protect themselves from infection
-nervous that women who were HIV positive might put holes in the female condom to infect them
-encourage women to have extra-marital affairs |
-reduce eroticism |
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