Uganda grooms its future

KAMPALA, UGANDA
IN THE 46 years since gaining indendence from Great Britain, Uganda has moved from the murderously destructive era of Idi Amin and Milton Obote to more than two decades of relative stability under President Yoweri Museveni. While nearby countries such as Somalia, Sudan, the Democratic Republic of Congo, and Kenya have had to contend with wars and bitterly contested elections, Uganda is close to a final agreement with the leader of a rebel movement in its north that is now considered a spent force.

Uganda has had to pay a price, however, for the stability of Museveni's rule. The parliament's decision to approve a constitutional amendment in 2005 allowing him to run for president indefinitely has meant that Uganda has not passed a crucial test of any young democracy: a peaceful transition of power. It has also taken the pressure off Museveni to groom competent successors. When challenged on this point during a recent meeting with US journalists organized by the International Reporting Project, Museveni said grooming a successor is undemocratic. I groom "a process," he said.

In the 1980s, Museveni won respect within his own country and internationally as the first African leader to recognize the threat of AIDS and to mobilize his country against it. His nationwide campaign exhorting young people to delay sex, married people to remain faithful (the catchword was "zero-grazing"), and others to use condoms reduced the percentage of HIV-infected Ugandans from 18 percent in 1990 to 7 percent in 2005.

The infection rate has increased recently, however, and AIDS remains a devastating problem, not least because of the thousands of orphans - many themselves infected - that it leaves in its wake. Uganda, a nation of 31 million, has 70,000 to 130,000 new infections annually. With a population of 300 million, the United States has 40,000.

Despite such data, Museveni has resisted lending his support to another method of limiting transmission of the AIDS virus: the circumcision of adult men. In the last two years, three randomized clinical trials in Africa - including one in Uganda - have demonstrated that circumcision can reduce a man's chance of infection by more than 50 percent. The Uganda researchers also found that the circumcised men were no more likely to engage in unsafe sex - possibly because the trial organizers made clear to all participants that any protective benefit would be less than 100 percent.

Since the clinical trial ended in 2007, the Rakai health center in southern Uganda where it was conducted continues to provide circumcisions to men seeking them. During my recent visit to Rakai, volunteers for the procedure included 61-year-old John Sesango, a farmer with a wife and nine children. "I also have a life to protect," he said, adding that he is taking care of ill relatives and does not want to become sick himself. Next to him sat 28-year-old Tadeo Sengozi, who said his stepfather had died of AIDS.

Circumcision has support in the Ugandan health ministry, but Museveni remains skeptical. The president said "reckless behavior" is the root of the AIDS problem. When I pressed him on the need to take new measures against the disease, Museveni referred to Ugandan tribesmen who have long practiced ritual circumcision but still become infected. He said only that he would "study the science" of circumcision as a preventive measure and "see."

Museveni also parts company with public health orthodoxy on the issue of limiting population growth. Although Ugandan women have an average of seven children each and the country's birth rate is the third highest in the world, Museveni said the nation's problem is not overpopulation but underdevelopment. He said Uganda's mild climate and adequate food supplies encouraged "complacency." In countries like India and China that have much greater populations competing for scarcer resources, he said approvingly, individuals are forced to strive harder. The role of Uganda's leadership, he said, is to vitalize the population.

Museveni would like to see much more industry in his country, which is now overwhelmingly a land of small subsistence farms. Two hurdles to that goal are the country's axle-busting roads - its only limited-access highway is still incomplete - and its inadequate supply of electric power. Many would-be investors will also be turned off by its endemic corruption. A Uganda spokesman for Transparency International has said that more than half the federal budget goes to graft. One of the most notorious cases in recent years involved misuse of money from the Global Fund to Fight AIDS, Malaria, and TB.

Drawing a line against corruption in Uganda is not easy. Recently, police there charged officials in rural health clinics with stealing government medicines and selling them privately in their own pharmacy businesses. When I asked the director general of health services, Dr. Sam Zaramba, why the ministry did not simply forbid government employees from operating such businesses, he said that would be impossible - the government salaries paid them are too low to place such a requirement on them.

In the future, Uganda is more likely to be able to pay its health officials adequately, hire enough school teachers, and solve its infrastructure problems if it reduces its population growth rate. That is a public health issue that deserves the same resolve that Museveni - to his everlasting credit - once devoted to fighting AIDS.

DONALD MacGILLIS