Following the Orientation and Scenario-Building Workshops, the project carried out a number of interviews to undertake more detailed analysis in specific areas.

Q: What is the story of the Uganda Aids Commission, particularly in the early days? How did it evolve?

A: You first need to understand what was going on 2 to 3 years before the commission was put in place. In 1986 there was a change of government in Uganda and President Yoweri Museveni took over power after a protracted war.  The first AIDS cases appeared in Uganda in 1982 but very little had been done about it. In 1986 there was a realisation of the problem. First of all certain army officers that were sent for training abroad -- about 35% -- were found to be HIV positive. There was a realisation that the country was facing a problem.

Therefore the president took it upon himself to come out and say: “Look, we have got AIDS.” In the UN General Assembly of May that year, the Ugandan Minister of Health informed the whole world that there was a problem with AIDS in Uganda. And because the president felt that this was a serious disease, he got involved and took it upon himself to mobilise the people and tell them what needed to be done – to take appropriate tests and what would happen across the country.

By the end of 1986, the president was chairing monthly HIV meetings where he would invite people from the Ministry of Health, other sectors and civil society to discuss HIV/AIDS in the country.

This approach to HIV went beyond the health sector. We initiated a multi-sectoral approach - setting up AIDS control programmes that involved other sectors other than health. This concept of involving many a sector including civil society culminated in the setting up of the Uganda AIDS Commission in 1992, so that it became inscribed in law and part of the legal framework. And this is, of course, a national body, which was working to involve all partners of society, non-governmental organisations, societies, the church and government and communities to plan an effective response, to be able to harness actors to work together and to be able to act as an advocate for HIV/AIDS work, to be able to co-ordinate the relevant information on HIV and disseminate it to everyone in the country and to be able to look at the research and evaluate it. 

I have just given you a summary of the Law and the functions of the Commission. The Law stated that the Uganda AIDS Commission would be answerable directly to the President and the President would appoint a board with a Chairman, with its eighteen members drawn from the government and non-governmental sectors, People living with HIV/AIDS and key individuals. The Commission is chaired by a fulltime Chairperson, assisted by a fulltime Secretariat. There would also be a Director-General appointed by the President, who is also the Chief Executive and Secretary to the Commission. The Secretariat are therefore employees of the Commission and not civil servants like other civil servants in ministries.

So that is how the commission was born in Uganda.

Q: How did you reach out to civil society in all its forms and civil society on the ground?

A: Now, the good thing that happened in this country -- because of the leadership of the President, because he went around the whole country telling everybody that they must rise up to the occasion, that AIDS was a condition that we needed to address—the message was spontaneously supported by the people and the communities. The church and other major national non-governmental organisations also came on board. More and more people joined in, so we had many initiatives working together on how to try and support the fight against HIV/AIDS. As I said, the commission was there just to make sure that these organisations are helped in terms of finding resources for them, working with them and advising them on what to do.

Q: In Uganda, you managed to inform the people before they had heard much about AIDS. What would you advise somebody to do in circumstances where there is already a lot of conflicting information about AIDS available to the public at large? What could you do differently?

A: One of the lessons that we have learnt over the years is that the most important thing in the fight against HIV/AIDS is to give the people the right information using every forum possible, whether it is print media, whether it is electronic media, whether it is radio stations, or whether using church forums. At every level--and political leaders should be in the first rank—we should be able to provide this information to the people.

We’ve just done a study, for example, in this country and found that one of the most effective weapons that have made people aware of AIDS and gets them to change their behaviour, is to pass them information, especially through the radio. There are 112 FM stations in Uganda and nearly every local language is covered.

Q: Do you have any control over the message that goes out?

A: That is another challenge - what normally happens is we have worked on these messages with these FM stations. The FM stations are contracted and paid to pass these messages on. Radio is the main channel of communication because what we have found in our reviews and study is that not everybody reads newspapers and most of them are in English anyway and some people don’t understand English. So the people themselves have told us that when we want to reach them, the most effective way is to use radio because they broadcast in any language.

Q: What particular forms of broadcasting work best?

A: In the beginning we followed other approaches, but we are now seeing that interactive messages work. Messages that are interesting are inserted with interesting material, like sports, are particularly effective. People get bored very quickly by the way, if you keep on telling them -“you die, you die, you die”. We must move away from the old theory that you must frighten people in order for people to change. Because at the beginning the messages were - “if you get AIDS, you’ll die”- you see that type of thing, which were meant to frighten people. But we’ve learnt that in fact that human beings, if you keep on telling somebody that “you’ll die, you’ll die, you’ll die”, eventually it doesn’t make sense. It stops making any impact on you.

Q: How did the religious leaders come on board?

A: At the beginning it was not very easy - the religious leaders thought that HIV/AIDS was basically a disease or a condition for people who were sinners and not following the Bible and at the beginning they felt that talking about AIDS was not a matter for religion. But I think as time went on and churches realised that they have a part to play - because if their flock are dying, clearly the church must play a role. If you have a crisis with orphans of Christians who are dying, the church must come out and play their role. If people are sick in their homes, they’ll not listen to you talking about the Bible when the guy is very sick.

So the church was transformed into one very, very, mighty weapon of advocacy, of being able to care and provide home-based care for people who are sick, pastoral and spiritual care for those who are sick, as well as advocacy about AIDS and how people can protect themselves.

Q: Do you often meet with the religious leaders?

A: All the churches in this country have formed an inter-religious council to deal with HIV/AIDS. And on many occasions when we have meetings on AIDS, we invite officials from the inter-religious council to come and join us.  

Q: Is the same message preached at high level and on the ground?

A: In Uganda, having been the epicentre of HIV/AIDS in Africa quite early on, there have been a lot of deaths that have traumatised families all over the country so that in this country there is hardly a person who has not lost either a relative or a friend. Over 25% of households are impacted and have one or more orphans that they are caring for – most of them due to AIDS. So even at this stage, everybody has been touched by this epidemic. 

Q: Are there any other points you would like to make?

A: The very important message that we are concentrating on now, is to make sure that the youth are free of the virus that causes AIDS. Youth are the future and if the youth can be kept free then you’ll be sure that the prevalence and infection will be able to go down in the whole country and the communities. So the programmes that we are trying to concentrate on to make sure that the youth are given  messages like - please abstain - you can until you are ready for marriage, delay the time when you start sex and really if you ever get married, be faithful. For the youth, these are the needs. Condoms are there and you must use them if there is a risk.

Q: Is there any special way to give the message to youth?

A: We have big forums, which we have formed, in the country. We have arranged these forums that travel around the country where many thousands of youth leaders collect and we give them this message and everybody is encouraged to talk to the youth.

We have got a programme for primary schools where every two weeks all primary schools hold assemblies and teachers have been given handbooks and guidelines of what to discuss with children in school. So we have quite a number of avenues on how we try and reach the youth. Primary education in Uganda is free. The number of children enrolled in primary schools in Uganda is about 7 million and Uganda’s population is 24 million, so every single day, nearly 30% of the total population are in primary school. If you can reach this 30%, you can have a big impact in the future of the direction of this epidemic.

Education is one of the priorities in terms of getting our country to develop and alleviating poverty, because illiteracy leads to poverty and disease and many other things. So it is a deliberate policy by the government to provide free primary education. Within the next year, secondary education also most likely will be free.

I think another point is that leaders of these countries must not just talk, they must show the way by example.

Q: In terms of traditions and cultural systems - have you had to force any change on that front?

A: It is true that many of the cultures and traditions in Africa-- for example widow inheritance -- have been discouraged as much as possible. And of course also in our culture there is a culture of girls being married off very young and early. We’ve tried to discourage this - first of all when you provide them with education; you offer them an alternative to stay in school. But if children are in the village and they are doing nothing, the tendency is for illiterate parents to marry them off. There are also very strong penalties for rape in this country -- rape is punishable by death. It is a deterrent. In our country, we have cultural leaders which people believe in, kings in various areas. We involve them actively in the campaign on various issues on AIDS. We involve them both individually and collectively.

For those who undergo circumcision, we try to encourage them that during the process they should make sure that they are not sharing the instruments. All these things have caused problems- it is a very big predisposing factor. Boys in some cultures are circumcised at puberty, when they are about 16 or 17, so you can never be sure what you are passing on by using the same knife.

In our culture, unlike the West, boys are supposed to be like lions, so that into and through manhood sexual prowess is something to be proud of, whereas girls are supposed to be submissive. I think we must try and tell the people that in fact it is not quite right – try and tell the parents: No, because of vulnerability to HIV, it is important that the boys and girls try and delay sex as far and as much as possible till marriage.

Q: In terms of behaviour change – have you managed to make many inroads?

A: We undertook action research last year in the country to try and assess what we have done, and what works. It was funded by Pfizer. The aim was to look at communities and ask people what they are doing and what it is that has made them change. What they have said is that information about AIDS has made them change their behaviour – quite a significant number of people are abstaining, a number are being faithful. Those who are not being faithful and abstaining use condoms in circumstances where they fail.