The people of Uganda's remote, northeastern Karamoja region managed to avoid the onslaught of HIV experienced by the rest of the country in the 1980s and 1990s, but just as the government is bringing the national epidemic under control, HIV rates in Karamoja are spiralling ever upwards.
"Ten years ago the prevalence was 0.4 percent and now it is 2 percent - that's a five-fold increase," Dr Vincent Owiny, the director of health services in Karamoja's Moroto district, told IRIN/PlusNews.
The parched region is a world apart from the rest of the country, remaining almost untouched by modern developments such as tarmac roads and electricity. Its people have rejected Western culture in favour of their traditional pastoralist lifestyle, a factor many credit with keeping HIV rates low in Karamoja's three districts of Kotido, Moroto and Nakapiripirit.
But the conservative values that once worked as a bulwark against the spread of HIV are now preventing effective action. Condom adverts might be common place in much of the country, but in Karamoja the condom is not only rare, it's a dirty word.
Munyes Santina, 22, dressed in her trademark Karamojong pleated skirt and striped black and red top, explained that in her culture, condoms were associated with promiscuity. "You marry and then you have your husband, so who would need one? They are for 'malayas' [prostitutes]," she said.
|You marry, and then you have your husband, so why would you need [a condom]?
In order to tackle the region's insecurity, an increasing number of security forces are based in Karamoja, and inevitably there has been a corresponding rise in the local sex industry. Dr Arturo Silva, at Moroto's Matany hospital, says many of the soldiers tested at the hospital have been found to be HIV-positive.
Matany is a missionary hospital and does not distribute condoms, but it does promote their use. "The hospital is Catholic but we are in favour of using condoms," Silva said. "We have 60 community health workers who advise, but the result in the end of the day is the problem is growing and growing."
The International Rescue Committee (IRC) plans to start making condoms available at sub-county level health centres later this year.
Esther Opoko, who works with the IRC in the region, says three years ago, when they began to survey the region's needs, condom use was unthinkable. "Back then we wouldn't even mention the word," she said. "Things are changing."
However, she noted that unless women's role in Karamajong society changed, condom use would not become prevalent: "Here a woman is supposed to be very submissive; she can't even talk about it and so she can't negotiate about using a condom."
For the director of health services, Owiny, more than just condoms are needed - a comprehensive HIV/AIDS package is necessary. "Before we start condom awareness we really need to just concentrate on making people aware of HIV/AIDS, people still don't really understand it," he said, adding that the region had been neglected by HIV/AIDS programmes, barely getting the basics in terms of AIDS education, treatment and care.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions