Two recent studies have illuminated an alarming trend in Uganda: HIV policies
that do not link or integrate family planning and reproductive health programs
are missing the mark and putting more people at risk of contracting HIV. The first,
conducted by the Uganda AIDS Commission, shows that married couples now account
for the highest proportion (42%) of new HIV infections in Uganda. The second, a
recent Guttmacher study, found that 40% of births in Uganda are unintended.
The evidence is mounting: The current approach to family planning and HIV
prevention is not working. As the global leader in both, the U.S. must shape its
policies and funding to respond to the reality Ugandans—and women around the
According to the Uganda AIDS Commission, lack of knowledge of HIV status,
engaging in sex with multiple partners, and lack of condom use are among the
reasons for the high infection rate among married couples. Currently,
PEPFAR-funded HIV/AIDS prevention programs overemphasize abstinence—an
inappropriate message for married couples. This is further evidence that
PEPFAR’s requirements do not always make good use of limited funds. Countries
receiving PEPFAR and other reproductive health assistance must be able to
determine for themselves the most appropriate approach for addressing critical
health issues—without misguided policy and funding prescriptions that hamper
individual countries’ efforts.
In addition to ill-suited policies, the neglect of funding for family
planning programs has very real consequences for Ugandan women and their
families. The unmet need for contraception is 35%, the lifetime risk of maternal
mortality is 1 in 13, and it is projected that one million people living in
Uganda will become HIV-positive in the next five years. According to former U.S.
Ambassador to Uganda Steven Browning, 90% of pregnant HIV-positive women do not
wish to have more children.
These statistics illuminate a dangerous and deadly future for this country if
current policy and funding trends continue. This closer look at Uganda reveals
many of the holes in the current U.S. prescription to address high and growing
rates of HIV and unintended pregnancies. PAI urges the U.S. to set aside the
policy restrictions that keep countries from designing integrated HIV and
reproductive health and family planning programs that meet the needs of their