ABSTRACT

Since the 1990s, Uganda has made dramatic improvements in reducing HIV/AIDS prevalence rates and has been at the forefront in the global fight for disease prevention, awareness and advocacy. However, ignorance and stigma attached to the disease has not been entirely eradicated and, as in many countries in East Africa where prevalence rates had also either declined or remained stable in recent years, the number of HIV/AIDS infections is again rising. Although the picture is complicated by regional, gender and age group differences, the UNDP states: ‘Infections are now on the rise in Uganda, with an estimated 130,000 new infections annually. This is close to the total number of infected people at the height of the epidemic in 1994’ (2013). This is partly because of growing complacency concerning the disease, especially among young people (Kidimu 2009), but is also a possible consequence of the influence of external donors (especially the U.S.) in shifting government policy towards abstinence. According to the most recent UNAIDS survey, prevalence rates among Ugandans between the ages of 15 and 49 now stand at 7.3 percent and are even higher in women, at 8.3 percent, up from 6.4 percent in 2004-2005 (UNAIDS 2011). As in most sub-Saharan countries, Ugandan women are particularly vulnerable, with consistently higher prevalence rates being reported; women in urban areas have higher prevalence than those in rural areas (11% versus 8%) (UNAIDS 2008, 2011). Patriarchal cultural and social relations mean that women lack the capacity to negotiate safer sex. Associated stigma means that they often delay seeking diagnosis and treatment, which renders the disease more difficult to treat. Women are put at greater risk by cultural practices, including female circumcision, polygamy and ritual sex (Sengendo and Sekatawa 1999), as well as by sexual abuse. Poverty and lack of education mean that for many women, sexual relationships are a means of achieving economic security, either through selling sex for money or goods and services, or forming long-term relationships with men (Nabulime and McEwan 2011).