1. Uganda: Case Study of
Successful Behavioural Change
for HIV Decline
Geoffrey Setswe, PhD.
Capacity Building Workshop
Gallagher Estate, Johannesburg
30 November 2009
2. What happened ?
• HIV prevalence declined from 21.1% (1991) to 9.1%
(1998): over 50% reduction in less than a decade
• Declines in incidence occurred before resources
allocated for formal interventions (pre- condoms,
VCT, etc)
“The scale of changes was equivalent to a vaccine of
75% efficacy.” …Stoneburner, WHO 2000
3. Why did it happen?
• Basic behavioural response to avoid HIV risk
associated with multiple partners
• Substantial decline in sexual partners was by far
biggest difference across age groups
• Reported changes:
48% men & women – “stuck to one partner”
11% men, 14% women - “chose to be sexually inactive”
12% men, 3% women – “used condoms”
5. How did it happen?
• Community & political efforts reinforced each other,
but impetus came from communities
• Changes made were not piecemeal, life did not
continue as before
• Gov. comm. programme: direct & focused
* risk avoidance #1- “zero grazing”
* main messages directed at men
• Communicating HIV/AIDS effectively shifted from
formal to informal
7. Beyond messages, media & public health
campaigns:
3 key features of Uganda communications
1. Communication through personal sources
* PLWHAs toured country, told stories.
* Cultural, community & religious leaders fully engaged
(musicians, DJs, craftsmen, chiefs,
teachers, pastors, etc)
“It was not so much individual or partner communication
but rather community level communication processes
within social networks that was significant in
influencing behavioural norms”
(Anglican Bishop on Uganda AIDS Council)
8. 2. Great transparency about disease.
• Campaigns captured realism of HIV/AIDS
did not gloss over or down play the experience
(balanced healthy living & widespread suffering)
• Real efforts made to personalise epidemic,
to create rippling social pressures
9. 3. Communication promoted attitude
of care
• First Lady urged support for families, orphans
• Promotion of “shared confidentiality” – openness of
HIV status with a limited circle of trusted people
• Concentrated on building social capital for managing
epidemic (TASO care networks)
10. Top 3 lessons from Uganda
1. Primary behavioural change on a large scale is
possible
2. Reduction of sexual partners, most esp. concurrent
partners, can have a huge impact on HIV at the
population level
(due to break up of scope & connectivity of
sexual networks)
11. Even Low degree sexual networks create a transmission core
Mea Mea Mean: Mean:
Number of n: n: 1.80 1.86
Partners 1.68 1.74
Largest
components
Bicomponents
in red
In largest
component:
2% 10% 41% 64%
Source: Martina Morris, Univ. of Washington, used with permission from a presentation given at a
meeting on concurrent sexual partnerships and sexually transmitted infections at Princeton University, 6 May
2006.
12. 3. Behavioural change succeeded because
it made people think about
a) their sexual behaviour
b) the consequences
c) avoiding risks they were able to avoid
13. The “social vaccine” or the “silent cure” for
HIV/AIDS found within communities offers
the best hope for long-term sustainable
solutions to this crisis
Thank you
