Uganda has been in the world headlines since the mid-1980s, first as a nation severely hit by HIV and AIDS, and later, from the late 1990s onwards, as the first country in sub-Saharan Africa that has managed to reverse a generalised HIV epidemic. Countless newspaper articles, television and radio documentaries and broadcasts, papers, books, and films have been produced about AIDS in Uganda, making the epidemic one of the most thoroughly researched and documented in the world. Medical doctors, virologists, epidemiologists and social and behavioral scientists, both Ugandan and expatriate, have produced massive amounts of scientific information about it since the early 1980s, in addition to which there have been policy papers, evaluation reports, and action plans produced by various government ministries, international donor agencies, and national and international NGOs and relief organizations which document the epidemic from administrative, developmental, and humanitarian perspectives.
Uganda's AIDS epidemic has been publicized worldwide through the news media and various international agencies. It is being constantly monitored not only by national authorities and international health experts, but by myriads of Ugandan and international organizations, media, academics, and concerned members of the public using modern means of communication. Some of these national and international bodies not only monitor, report and educate, but demand their say in how the epidemic should be managed. Uganda has become a testing ground for medical and behavioral interventions, as exemplified by AIDS vaccination trials, the social marketing of condoms, antiretroviral treatment, and, recently, by the male circumcision trial. Positive results have then been marketed to other countries in sub-Saharan Africa as successful AIDS prevention strategies.
It seems that becoming a testing ground for AIDS interventions is the price Uganda has had to pay for deciding, in the face of rising AIDS death figures and HIV infections, to open its doors wide to the international aid organizations in the early 1990s. Since then the number of AIDS-related activities undertaken by various officials and organizations has grown to unforeseen proportions. There are AIDS programs in all government ministries, in private companies, institutions of learning, religious groups, the military, and the police. NGOs and community-based organizations (CBOs) provide counseling, care, treatment, and psychosocial support. Since the early 1990s Ugandans have been bombarded with AIDS education messages by the government, the religious groups, and the NGOs.
At the same time, however, the centralization of the management of AIDS-related activities in the president's office and the Uganda AIDS Commission, in order to achieve better control and effectiveness, may have had negative impacts by shifting the planning away from the realities of the field, while field activities (still under the Ministry of Health AIDS Control Programme, or ACP) may not have been able to follow the frequent shifts in focus. This may have created rigid hierarchical power structures in which the flow of information between the bottom and top may be arrested, and it may have caused unnecessary bureaucracy and paralysis in decision-making, when even the slightest action had to be given approval from the top.1 Thus, while administration of the activities linked to the control of HIV and AIDS has become more complex, the areas of responsibility and accountability have become blurred, corruption has increased, and the message of the whole anti-AIDS campaign-in the hectic world of priorities that shift rapidly according to the latest whims of donors and international NGOs-sometimes seems to have been lost.
The bottom line of every national AIDS control program should be that people at risk of HIV or affected by it should receive health education, treatment, care, and support as they need it. …