Bad. ‘Uganda was a beacon of hope in Africa’s struggle against HIV, but the Christian right’s grip on US policy is undermining this effort with fatal consequences, reports Oliver Duff from Kampala.’

Aids activists and development officials point to the 130,000 Ugandans infected with HIV last year alone – up from 70,000 in 2002 – and say the recent obsession with abstinence is handicapping the country’s once-successful fight against the virus. Health workers see the fingerprints of America’s Christian right all over the chastity message and believe the Bush administration is using its financial might to bully them into accepting evangelical ideology at the expense of public health…Uganda receives more US money than ever…But that cash comes with conditions: in a gesture to the Christian right in the US, at least one-third of all prevention money must go to “abstinence-only” projects…Critics counting each new infection in field clinics say this has dangerously skewed Uganda’s previous “balanced” approach which seemed to be working.

Working, yes, but at the price of allowing some people to go with condoms instead of abstinence, and that’s dirty. It’s better to make the dirty people be dead and only the clean people live. Except that gets tricky, because you can get people who are faithful (one of the items in Uganda’s ABC – abstinence, be faithful, condoms) but are infected by their partners; that usually means women being infected, because male to female transmission is much easier. And then there are the children they have, and the children they leave orphans, some of whom are forced to become prostitutes to survive, and quickly get Aids and die themselves. But maybe it’s worth it, to keep from allowing condoms to appear on billboards and remind everyone of sex? Maybe not.

“Because of the US, our government now says Abstain and Be faithful only,” says Dr Katamba. “So people stop trusting our advice. They think we were lying about how condoms can stop Aids. Confusion is deadly.” And so it is proving to be: the number of infections is again rising, after years of decline…The trusted and influential first lady, Janet Museveni, is a born-again Christian. She has publicly equated condom use with theft and murder and said that Aids is God’s way of punishing immoral behaviour.

Aids is God’s way of punishing immoral behaviour in men by infecting their wives and leaving their children orphans. Interesting view of punishment, isn’t it.

People on both sides of the argument agree that Washington is prolonging tens of thousands of Ugandans’ lives through treatment – and that abstinence is crucial. “The evangelicals are absolutely right: abstinence is the best way of preventing the spread of HIV/Aids,” says Sigurd Illing, the EU ambassador to Uganda. “But some people aren’t receptive. We need an end to this bedevilling of condoms by people who take a high moralistic stance and don’t care about the impact that this has on reality.”

Ah yes, reality. Now where have we heard about that before…

“Saying ‘abstain’ is not realistic.” Nor is saying “Be faithful” at present, given the widespread and accepted male infidelity in Uganda that results in one infected person spreading the virus quickly…Constance Namuyiga, a 28-year-old mother of three young children, found out she was HIV-positive two years ago. “Men think they own us here,” she says…Not everyone is sad about the escalating epidemic. In a roadside timber yard near Kampala’s Mulago Hospital, coffin makers report that business has never been better.

Oh, good, that’s cheering.