I’m in a taxi heading back to Boston, postcall from Newton–Wellesley Hospital. As an intern at Mass. General, I spend a month-long rotation out at this Partners-affiliated community hospital, learning to practice medicine in a setting that is in some ways very different from the ter tiary care center where most of our training takes place.
The driver of the cab has an accent, and I ask him where he is from. It turns out he is from Uganda. I know very little about his home country, except what I have read about Ugandan president Museveni, who mobilized the country early in the fight against HIV/AIDS by breaking cultural taboos on speaking openly about the means of spread and strategies to prevent transmission.
Mr. C, I’ll call him, was just entering adolescence in the late 1980s and early 1990s when HIV/AIDS claimed 30 percent of the Ugandan population. Everyone from his country, he tells me, has someone in the family who died of the disease, although then, and sometimes now, the cause of death was not widely discussed or even mentioned within the family.
He relates a time when he was in middle school when a famous pop singer, Philly Bongoley Lutaaya, came to visit his class. Lutaaya was well known throughout Uganda and the rest of Africa and, in fact, had been so successful in his career from the 1960s to the 1980s that he had settled in Sweden and was living a glamorous life. But he had also contracted HIV. While he was dying of AIDS, he decided to go public with his illness. Lutaaya used his music to create a new openness about the risks of sexual transmission. Mr. C tells me he will never forget Lutaaya. The image of this once vigorous and very successful cultural icon turned skeletal by the illness has stayed with him always.
Uganda’s success is difficult to overstate: between 1993 and 1998, the rate of HIV infection among pregnant women in the capital city fell from 31 percent to 14 percent. Among pregnant women elsewhere in the country, rates also declined dramatically, from 21 percent to 8 percent over the same time period. These and other statistics have made Uganda an anomaly on a continent where HIV has led to a decline in life expectancy, a generation of orphaned children, and devastation to already struggling economies. In 2005, the seroprevalence rate among Ugandans aged 15 to 49 was 6.4 percent.
How has Uganda accomplished this dramatic reversal? Most important, in many respects, was the leadership of the country’s president, who involved all sectors of society and started sex education programs in schools and in the media focused on teenagers. The nation’s “Multisectoral Approach to the Control of AIDS” was established in 1992 and passed by the parliament in the same year. By 2001, there were at least 700 agencies across the country, including local and national agencies, and faith-based and private-sector organizations.
Uganda is currently working toward providing antiretroviral therapy to those infected and has achieved 60 percent coverage of those eligible. Planners in the National Strategic Framework, which coordinates the national response to HIV/AIDS, are also looking ahead to the development of drug resistance and have emphasized counseling to promote adherence to drug regimens in the hopes of reducing the development of resistant organisms.
Thousands of miles away from Uganda, Mr. C is reminiscing on the changes his country has gone through and how far it has come. Here in Boston, he keeps up with current events on the internet. In fact, as I’m leaving the car, he writes down the name of the pop singer for me to look up and suggests that I just “google” Lutaaya.
Erica Seiguer Shenoy, MD–PhD ’07, is an intern in internal medicine at Massachusetts General Hospital.
