Introduction

From the outset of the epidemic, a major constraint has been the lack of accurate data. People trying to combat the spread of the disease often lack information about the effectiveness of their efforts - unsure whether they have successfully encouraged behavioural changes, or the extent to which such changes have helped check the epidemic.

Few developing countries have made consistent efforts to monitor both HIV prevalence and risk behaviour. Many still do not consider HIV/AIDS a sufficiently high priority - or are reluctant to raise in the public domain matters considered too personal or intimate. Some countries may even believe that the publication of survey results will raise unnecessary alarm or discourage trade or tourism. At the beginning of 1997, probably fewer than ten developing countries had carried out repeated surveys to assess behavioural change and condom use at the population level.

Uganda is one of the African countries where the HIV epidemic was recognized early and is one of the most severely affected. Government, NGOs and other institutions in civil society have been determined to deal with the issues openly and directly, and have placed Uganda in the forefront of the fight against HIV/AIDS. This has ensured not only that Uganda has one of the most vigorous and wide-ranging programmes to combat the epidemic, with some success in limiting HIV spread especially among urban youths, but also that it has started to develop consistent systems of monitoring. These activities are far from perfect, and the results are still subject to a variety of interpretations, but they are a clear example of what can be achieved even in a country with few resources and poor infrastructure - and offer experience from which other countries can benefit.

This case study looks at the tools that Uganda uses to track trends in HIV and trends in reported sexual behaviour. It also demonstrates links between the two.