Condom shortage in north affecting HIV prevention efforts

On a shelf in The Faith Drug Store at Unyama camp for the internally displaced, near the northern Ugandan town of Gulu, a box of 'Lifeguard' and a box of 'Protector' - commercial condom brands - sit between boxes of malaria and common cold medicines, but both are empty.

"We often run out of stock," admitted storekeeper Kevin Kipwola. "We buy one box of Lifeguard and one box of Protector from town each week, a total of 40 condoms."

No free 'Engabo' (shield) condoms are available in the camp. A severe shortage of condoms in northern Uganda is compromising efforts to curb the rising HIV prevalence rate, despite a growing demand for them, said senior health officials in two districts.

According to the 2004-05 Uganda Sero Survey, the national HIV prevalence rate is 6.4 percent, but in the war-scarred northern region it is over nine percent because people have little access to life-saving HIV/AIDS prevention, care and support services.

Dr Peter Kusulo, director of health services in Lira district, said they had received no Engabo condoms since mid-2005.

The erratic supply of free condoms to northern districts by the Ministry of Health in the Ugandan capital, Kampala, has prompted suspicions that a shift in government focus from condom promotion to abstinence and fidelity lies behind the depleted stocks.

Acknowledging the crisis, Vesta Kibirige, the government's condom unit coordinator, told PlusNews that the north could expect to receive a supply in June. "There are 2.5 million condoms in the National Medical Stores waiting to be distributed to the north, which should last up to two months."

A 20-year conflict between government forces and the notoriously brutal Lord's Resistance Army has displaced more than 1.7 million people, driving them into cramped, unsanitary camps. Poverty has led to commercial sex work, alcoholism and risky sexual behaviour, and sexual violence has also become common.

Efforts to raise awareness about the dangers of unprotected sex and transmitting the HI virus have increased the demand for condoms, but the director of health services in Gulu district, Dr Paul Onek, said they were unable obtain adequate supplies.

"The number of non-commercial condoms coming from the Ministry of Health has gone down. We used to get 50,000 every three months, but we have been out of stock for the last two months," he explained. Local health officials used to distribute Engabo condoms to drug stores, bars and hotels, but this has stopped.

They have also had to reassess their prevention message. "We have no Engabo in stock at the moment. In fact, we have been short in supply since mid-2005," said Kusulo. "IDPs [internally displaced persons] are asking us where the condoms are, so of course, we have toned down our sensitisation efforts."

SHORTAGE AFFECTING HIV PREVENTION WORK

Onek attributed the condom shortage to last year's batch of faulty Chinese-supplied Engabo condoms, which users complained smelt bad. Subsequent tests found defects, forcing the Ministry of Health to recall tens of millions of condoms, which undermined public confidence.

The government had to address negative public perception before releasing 'rebranded' Engabo, but the Ministry of Health has confirmed that the first batch is ready for distribution in the five northern districts of Apac, Gulu, Kitgum, Lira and Pader. The packaging now displays a yellow sticker designed to change the brand's appearance and reassure the public of its quality.

During the early 1990s, President Yoweri Museveni's administration pioneered a groundbreaking strategy, credited with cutting HIV prevalence from over 20 percent to its current level. The multifaceted approach, known as 'ABC', calls for abstinence until marriage, being faithful to one's partner, and correct condom use.

However, the government has increasingly been accused of shifting the emphasis away from the 'C' in favour of 'A' and 'B'. "The leadership's opinion changed to abstinence," Kusulo said.

Onek agreed, blaming the condom shortage on government policy. "People are now silent about condoms because of the attitude of top-level officials. Those who supported condoms started hesitating."

In a recent interview, former Minister of Health Jim Muhwezi assured PlusNews that there had been no shift in policy, and Uganda remained committed to the three-pronged approach of ABC.

"We need to continue with the message that HIV has no cure," he said. "We continue to use the same method: that you need to abstain, if you are young, until you have a lifetime partner to be faithful to, or to use a condom if you must."