Tuesday, April 7, 2009

The Rorschach Test

I'm on my way to Uganda to do some more reporting on the astonishing, and generally misunderstood, story of how this country emerged from devastating civil war in the mid-1980s to craft the most effective AIDS response in African history. It's a subject I've tackled before for The Washington Post. But for the purposes of book writing, I need to dig deeper, as well as feel the African sun on my skin and again marvel at the world's ugliest birds, which fly around Kampala, the capital.
Cynics often describe Uganda as Rorschach Test of AIDS: People see what they want to see. Some attribute the steep drop in new infection that began in 1989 (and ended in 1994) to condoms, others to abstinence. Some say good political leadership was the key, or maybe multi-sectoral approaches. Even Death, sometimes called the "D" of "ABC" prevention efforts, gets credit for the steep drop in AIDS rates.
I don't think much of this has held up to serious scrutiny in the years since scientists Rand Stoneburner and Daniel Low-Beer published their groundbreaking study in Science magazine in 2004. It showed conclusively that the drop in new infections tracked with major shifts in sexual behavior, away from multiple sex partners, casual sex and prostitution. Political, religious and cultural voices spoke together in those years, urging people to be more monogamous, or at least faithful to their spouses if polygamous. The resulting changes saved more than one million lives. And it all happened, and pretty much ended, before the wave of condom promotion that began in the mid-1990s and the abstinence programs that began a few years after that.
In any case, I'm hoping to have more to say in a few days. But my hunch is that Uganda's story is the opposite of a Rorschach Test. It was a moment of remarkable clarity, now lost and gone away. Those stupid blurry ink splotches, however, seem like they will be with us forever.

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