The U.S. government's emphasis on abstinence-only programs to prevent AIDS is hobbling Africa's battle against the pandemic by downplaying the role of condoms, a senior U.N. official said on Monday. Stephen Lewis, the U.N. secretary general's special envoy for HIV/AIDS in Africa, said fundamentalist Christian ideology was driving Washington's AIDS assistance program known as PEPFAR with disastrous results, including condom shortages in Uganda. Activists in both Uganda and the United States say the country is now in the grip of condom shortage so severe that men are using plastic garbage bags in an effort to protect themselves. A Kenyan clinical officer examines an HIV-positive child in Kenya's capital Nairobi August 23, 2005. According to UNAIDS, 88% of the 2.2 million children in the world living with HIV/AIDS grow up in Africa. (Wairimu Gitahi/Reuters)

Stephen Lewis, the UN secretary general's special envoy for HIV/Aids in Africa, said US cuts in funding for condoms and an emphasis on promoting abstinence had contributed to a shortage of condoms in Uganda, one of the few African countries which has succeeded in reducing its infection rate.

"There is no doubt in my mind that the condom crisis in Uganda is being driven by [US policies]," Mr Lewis said yesterday. "To impose a dogma-driven policy that is fundamentally flawed is doing damage to Africa."

The condom shortage has developed because both the Ugandan government and the US, which is the main donor for HIV/Aids prevention, have allowed supplies to dwindle, according to an American pressure group, the Centre for Health and Gender Equity (Change).

In 2003, President Bush declared he would spend $15bn on his emergency plan for Aids relief, but receiving aid under the programme has moral strings attached.

Recipient countries have to emphasise abstinence over condoms, and - under a congressional amendment - they must condemn prostitution.

Brazil announced last month that it would refuse to accept $40m (£22m) in American aid rather than stigmatise prostitutes who Brazilian health workers said were essential to their anti-Aids strategy. Senegal was also cut off from US aid because prostitution is legal there.

Campaigners accuse Uganda's first lady, Janet Museveni, of being instrumental in the switch towards a policy of abstinence. Ugandan government officials say that her religious beliefs, stemming from being a born-again Christian, are central to her promotion of the message of abstinence. In one poster campaign, signed by the office of the first lady, the slogan alongside the picture of a smiling young woman says: "She's saving herself for marriage - how about you?"

While Uganda needs between 120m and 150m condoms a year, only 32m have been distributed since last October, Change said in a report published yesterday.

Meanwhile, religious groups that oppose condom use are receiving an increased share of funding, the pressure group says. "Religious fundamentalists, some financially supported by the US government and the office of the first lady, Janet Museveni, have become prominent in attacking condoms and those who distribute them," Change's report said.

Officially, Uganda remains committed to the threefold "ABC" policy. The initials stand for "Abstinence, Be faithful, use a Condom". The Ugandan government denied yesterday that there is a scarcity of condoms or a policy change. The health minister, Jim Muhwezi, said: "It is not true that there is a condom shortage. There seems to be a coordinated smear campaign by those who do not want to use any other alternative simultaneously with condoms against Aids."

The minister insisted that condoms remain an important part of their HIV prevention strategy, but said the first lady could not be expected to promote the use of contraceptives. "Her role is to tell the young people to abstain. She cannot tell young people to use condoms, she is a mother," he said.

Uganda has had extraordinary success in reducing adult infection rates from 30% in the early 1990s to below 6% last year. This success is largely credited to its president, Yoweri Museveni, who spoke out about what was considered a shameful disease and told people how to combat it.

The row over Uganda's HIV/Aids strategy comes at a time when the financial management of the country's Aids programmes is under the spotlight. Last week the Global Fund for Aids, TB and Malaria pulled all its funding from Uganda's programmes. After an inquiry by accountants PricewaterhouseCoopers, the Global Fund suspended five grants worth $201m over two years and demanded that the unit within the Ugandan ministry of health that manages them should be disbanded.

An American Aids official last night denied that the US had forced Uganda to reduce the condoms available, saying the Bush administration supported condom use as part of a balanced programme that included prevention.

"The statements that I have heard are completely untrue and completely mischaracterise effective prevention programmes," Mark Dybul, deputy US global Aids coordinator and chief medical officer, told Reuters by telephone.

© 2005 Guardian Newspapers Ltd. (UK)

###