Uganda is one of the few Sub-Saharan African countries that has adopted abstinence-only sex education as an approach of sexual education that emphasizes abstinence from sexual intercourse until marriage as the only option. Abstinence-only sex education does not include joint curriculum covering other options including safe sex practices, family planning, and is espoused as the only sure way to avoid pregnancy and sexually transmitted infections. Uganda is commonly recognized as an exemplary case of lowering the rate of HIV prevalence.Cohen, J., & Tate, T. (2005). The less they know the better. Abstinence-only HIV/AIDS programs in Uganda pg 1. Prevalence figures may have also been distorted by the lack of treatment, meaning that the percentage of infected is decreased by disproportionately early deaths. Abstinence-only sex education has been implemented and supported for this cause to a large degree in Uganda, to some controversy. Critics have questioned its effectiveness in lowering HIV/AIDS transmission. They have also highlighted discrimination, gender inequality and social stigma as the outcomes of the program in Uganda.
Origins In the wake of an increase of HIV prevalence in Uganda since it first appeared in 1982,Stoneburner, R. L., & Low-Beer, D. (2004). Population-level HIV declines and behavioural risk avoidance in Uganda. Science, 304(5671), 714–718. many programs were introduced to lower incidence of HIV and educate about the disease. Abstinence-only sex education was implemented as one way to quell the spread of HIV/AIDS, in addition to creating a positive behaviour change to the same end over time. As the epidemic became known on the international scene, money and resources from many nations flooded Africa in general and Uganda in particular. Abstinence-only sex education in Uganda in the late 1990s onward was largely financed by the United States and independent faith-based organizations
Programs Abstinence, Be faithful, use a Condom (ABC) The ABC approach was introduced during the US-Ugandan efforts to propose Abstinence-only as a way to lower HIV transmission. ABC is an acronym, A being Abstinence, B being Be Faithful, and C being Condom use. It would seem that this form of abstinence-only includes some education and encouragement of condoms, but the application of ABC is disaggregated for specific populations. The breakdown is Abstinence for people not yet married, Be Faithful for those in marriages, and Condom Use only for people that are already infected or are in a marriage where one person is infected.
ABC has evolved since its inception to a program known as AB, released in 2004 as an official abstinence-only education program for Uganda specifically. AB has lessened the emphasis on condoms due to the confusing nature of teaching the two simultaneously and the fear that condoms undermine the message of abstinence. AB is criticized for its lack of follow-through of collecting data on whether participants are abstaining or not. The main source of data collected for AB is the number of AB rallies, organizations and discussions concerning AB, instead of the behavioural changes proposed by AB. Therefore, AB is difficult to monitor as the true success of the programs aims for abstinence and social modifications, but no data is kept.
Condoms, Needles, and Negotiation (CNN) Condoms, Needles and Negotiations was born out of the necessity of failing marital monogamy. CNN stands for Condoms, Needles and Negotiation. In sub-Saharan Africa, Uganda included, married women in monogamous relationships are at a disadvantage due to the lack of rights within marriage, bargaining power, and domestic violence.Sinding, S. W. (2005). Does ‘CNN’(condoms, needles and negotiation) work better than 'ABC'(abstinence, being faithful and condom use) in attacking the AIDS epidemic. International Family Planning Perspectives, 31(1), 38–40 The need was discovered as most new HIV cases come from HIV women contracting the disease in their marriage through their husbands. In this way, AB abstinence-only education falls short for protecting the lives of those practicing it. The Condoms part of CNN is two-fold to reduce condom stigma and promote use within the B (Be Faithful) section of AB. Women are still practicing faithfulness, but in order to protect their health, they still need to be able to understand and use condoms. The first N in CNN covers needle exchange, which doesn't relate to abstinence-only sex education. But the second N stands for Negotiation, which again plays a part for individuals practicing faithfulness who could still be harmed. Negotiation informs partners of the risks they might encounter if their partner is not being monogamous and teaches them skills to bargain in their position in the relationship.
Presidential Initiative on AIDS Strategy for Communication to Youth (PIASCY) In 2001, Ugandan President Yoweri Museveni introduced his official program for sex education for the youth of Uganda, Presidential Initiative on AIDS Strategy for Communication to Youth, abbreviated as PIASCY. PIASCY mainly targets primary schools, secondary schools and after school youth rallies with materials and instruction (HRW, 29). The main focus of PIASCY is for young people to empower themselves to delay their sexual relations until marriage through abstinence. PIASCY is primarily funded through the United States Agency for International Development and the U.S. Centers for Disease Control and Prevention, both of which provide many other services outside of finances to support the program. In addition, PIASCY has since become a foundation feature in the United States’ President's Emergency Plan for AIDS relief (PEPFAR).
Primary schools The medium for primary school involvement with PIASCY is a combination of manuals, instruction for teachers to relay to students, as well as materials given directly to the students based upon their age/grade. An assembly is normally held twice a month school wide for teachers to give presentations outlined from the curriculum within the PIASCY manuals. The first message is the choice of abstinence and its benefits, but subsequent lessons can include teachings of self-esteem and how to be above peer-pressure. Although other parts of PIASCY include correct condom application and uses, at the primary level, abstinence-only is the majority of the message.
Secondary schools In 2004, the Ugandan government incorporated PIASCY in secondary schools, in the form of handouts for students as well as teachers. The curriculum is disseminated in the classroom format on a regular basis. The secondary school level information was drafted to include age sensitive subjects such as masturbation, abortion and homosexuality, but was met with strong opposition from many powerful, yet undisclosed, groups in Uganda and the United States. In addition, draft copies of the secondary school handouts contained misleading and inaccurate information about condoms and HIV prevention. Furthermore, condoms were encouraged after marriage as HIV prevention, but did not explain how this differed with unmarried youth. The final drafts did include rudimentary instruction on condoms without the corresponding photos.
Out-of-school programs PIASCY also has a significant section of their focus targeting youth that are not in school by holding rallies and events after school or outside of school. In Uganda, there are significant numbers of youth that are not enrolled in school, despite the recent movements to educate everyone. Although these events are generally held on a school campus or facility, anyone aged 15–30, student or not can participate. These events generally have speakers who are as diverse as the President of Uganda to religious leaders. In more rural areas, these serve to disseminate important abstinence messages but have been criticized as supporting an agenda of re-election and political messages and including inaccurate information about condoms and abstinence. After the formal rallies and programs, it is made aware that political leaders are around to take questions that youth may have about the current government. PEPFAR, an organization providing funding to PIASCY, outlines promotion of information, prevention and treatment of HIV, and is in contradiction with the political agenda and misleading information sometimes found in the PIASCY after school programs.
Faith-based organizations In Uganda, there are a number of faith-based organizations that provide abstinence-only education to youth. Many of these are financed and supported by not only the Ugandan Government, but also the United States. In general, these are based on Christian beliefs, as 60% of Ugandans are Christian.Human Rights Watch interview, Kampala, November 10, 2004.
National (Uganda) Youth Forum The National Youth Forum was founded by one of the nation's largest activists for abstinence-only sex education, first lady Janet Museveni. The primary objective for the National Youth Forum (NYF) is to coordinate assemblies where young boys and girls pledge to stay sexually pure until marriage. More than 70,000 Ugandan youths have committed to this through NYF.Janet Museveni, "The AIDS Pandemic: Saving the Next Generation," World Congress of Families, New York, May 3, 2002, http://www.worldcongress.org (retrieved January 11, 2005). Anne Mugisa, "Janet to Host 70,000 Virgins," The New Vision, December 1, 2004, http://allafrica.com (retrieved December 2, 2004). NYF and Museveni advocate abstinence-only education in its most exclusive form, even pushing the notion that condoms are inadequate in preventing HIV and education involving them promote sexual activity among youth. She has gone so far as to propose a nationwide testing of young boys and girls for virginity, although this has not come to pass. Ms. Museveni's organization NYF also obtains funding from the American government.Priya Abraham, "Hooked on Failure Africa: In Africa’s Fight Against AIDS, the United States Continues to Support Family-Planning Groups that Stifle the White House Abstinence and Fidelity Message," World Magazine, November 6, 2004, http://www.worldmag.com (retrieved December 8, 2004). This relationship has been called under scrutiny on the grounds that UNF Proselytizing and the laws of the United States regarding the secular nature of congressional funding.A December 2002 executive order governing federal funding of community and faith-based organizations states that, in accordance with the U.S. Constitution's separation of church and state, "organizations that engage in inherently religious activities, such as worship, religious instruction, and proselytization, must offer those services separately in time or location from any programs or services supported with direct Federal financial assistance." Executive Order 13279—Equal Protection of the Laws for Faith-Based and Community Organizations, Federal Register, vol. 67, no. 241, December 16, 2002.
Makerere Community Church The Makerere Community Church is another national leader in the abstinence-only push. Martin Ssempa, who is one of the writers of the Ugandan AB policy, directs the church and foundation. Ssempa leads the fundamentalist Makerere Christian Church and his policies fall in line. He takes a more extreme version of abstinence only sex education, sometimes speaking out directly against condoms and women's rights. His is a more outlying approach to abstinence-only and the lifestyle that he connects with it.
Family Life Network