Sex Change In Uganda (Press, 5 September 1988)

In Rakai district, south-east Uganda, the impact of AIDS has been profound and alarming. Initially, the local population attributed the disease's onset to witchcraft or the invasion by Tanzanian soldiers in 1979. However, awareness has evolved, and it is now understood that AIDS is transmitted through sexual contact. The local community, primarily consisting of poorly educated individuals along a heavily trafficked trade route, has taken initiative in protecting itself from the epidemic. The Ugandan government has played a pivotal role in this effort, particularly under the guidance of its Minister of Information, known for his unconventional but insightful approach developed during his time at Cambridge. The government's campaign promotes the slogan “Zero Grazing,” which encourages individuals to engage in sexual relations only with their spouses, aligning with cultural practices, including among Muslims who may have multiple spouses. The campaign uses striking posters that caution against the allure of sexual indulgence, effectively instilling fear about the connection between sexual behaviour and the risk of death from AIDS. This approach appears to have resonated deeply within the community, as virtually everyone in Rakai district is personally acquainted with someone who has succumbed to AIDS, often leaving behind dependents. The tangible threat of the disease has prompted a behavioural shift among the population, mirroring trends seen in San Francisco where awareness of AIDS led to changed behaviours before widespread public education initiatives were introduced. The anecdotal evidence from Rakai's residents, including insights from local figures like Father Augustine Masaka, suggests that people are becoming more cognizant of how AIDS spreads and are adjusting their behaviours accordingly. A head nurse at the district's main hospital corroborates this shift, stating bluntly that people have recognised the dangers and are no longer engaging in previously risky behaviours. Uganda was the first country in Africa to establish an AIDS programme, and it is often regarded as the most effective. This success is attributed to its policy of open discussion about the disease, something many other governments were hesitant to address. As a result, the efforts in Rakai serve as an example of how community awareness and education can lead to significant changes in behaviour in the face of a public health crisis.

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