August 30, 2005
U.S. Blamed for Condom Shortage in Fighting AIDS in Uganda
By LAWRENCE K. ALTMAN
A top United Nations official and a number of advocacy groups for AIDS patients charged yesterday that Bush administration policy had led to a shortage of condoms in Uganda, increasing the risk of infection for many people, particularly married women and adolescents.
But the charges were disputed by the Ugandan government and an official of President Bush's emergency plan for AIDS relief, known as Pepfar. The plan emphasizes a policy known as ABC, which stands for abstinence, be faithful and use condoms.
The dispute comes less than a week after the Global Fund to Fight AIDS, Tuberculosis and Malaria, a public-private partnership based in Geneva, suspended $201 million in grants to Uganda because of government mismanagement.
In a telephone conference with reporters, the critics said that Uganda needed 120 to 150 million condoms a year and that this year's supply of fewer than 30 million condoms, distributed at health clinics, had been exhausted. Privately purchased condoms have more than tripled in price in Uganda, to 54 cents for a package of three, from 16 cents, making them unaffordable for many Ugandans, the critics said.
Jodi Jacobson, executive director of the Center for Health and Gender Equity in Washington, D.C., said that there has been a dangerous and profound shift in U.S. donor policy from comprehensive prevention, education and provision of condoms to focus on abstinence only. The shift denies information and technologies to people at greatest risk of H.I.V., she said.
Condoms have become difficult to find in cities, even for a price, and are unavailable in many rural areas, the critics said, and some men have begun using garbage bags as condom substitutes to prevent H.I.V. infection.
Ambassador Stephen Lewis, the United Nations secretary general's special envoy for H.I.V./AIDS in Africa since 2001, and the former Canadian ambassador to the United Nations, said that there is no question that the condom crisis in Uganda is being driven and exacerbated by Pepfar and by the extreme policies that the administration in the United States is now pursuing.
Mr. Lewis said the emphasis on abstinence in the administration's program, even more than the issue of condom distribution, is a distortion of the preventive apparatus and is resulting in great damage and undoubtedly will cause significant numbers of infections which should never have occurred. 
The Ugandan government is providing condoms mainly to prostitutes and truck drivers, the two groups who are considered at highest risk.
But, Mr. Lewis said, How do you save married women, who have no choice?
Referring to the fact that Uganda had been praised in the past for its AIDS prevention programs, Mr. Lewis said it was the ultimate irony that the country and the political leadership most dramatically associated with the decline in prevalence rates seems to be de-emphasizing the use of condoms.
He said he had not discussed the condom issue directly with representatives of the Pepfar program.
Ms. Jacobson said that last October Uganda issued a nationwide recall of the Ugandan brand of condoms, contending that they were of poor quality, causing a shortage. The government also levied new taxes on imported condoms.
Beatrice Were of ActionAid in Uganda and the Health Rights Action Group, however, said that tests performed on the condoms in the United States found them safe and effective. She said religious groups in Uganda have used the initial claims to undermine confidence in condoms and contribute to misinformation about their effectiveness.
But Dr. Mark Dybul, the deputy coordinator of Pepfar and its chief medical officer, said in a telephone interview that American officials in Uganda told him yesterday that there was no shortage of condoms there, but that there could be one if the country does not receive current orders. 
The Bush administration has supported the purchase of 15 to 20 million condoms that are in a warehouse in Uganda awaiting further testing to tide them over if there is a shortage, Dr. Dybul said.
The Ugandans know how to handle their epidemic and developed the ABC program as their response to the epidemic, he said.
Uganda sent condoms for independent testing and found them faulty, Dr. Dybul said. The testing is an appropriate public health measure that any country would demand to prevent infections through faulty condoms, he said.
Mike Mukula, the state minister for health in Uganda, told The Daily Monitor newspaper in Kampala that the country had enough condoms. We just procured 65 million condoms about two months ago and another 80 million are on the way, he said.
Mr. Mukula also contradicted the critics' estimate of Uganda's condom needs, saying the country uses about 5 million condoms a month and that with a well-stocked store there is no cause for concern about a shortage.