The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) -- the $15 billion program bringing prevention, care, and treatment to Uganda and 14 other hard-hit countries -- has come under fire by Ugandan activists and government officials. They say it has shifted emphasis away from condoms toward an unrealistic call for abstinence and fidelity in a country where 1 million have already died of AIDS and an estimated 900,000 are HIV-positive.

Once one of Africa's most HIV-infected countries, Uganda authored the groundbreaking multi-pronged ABC strategy, which stresses abstinence until marriage, being faithful to one's partner, and consistent and correct condom use. This approach is credited with cutting the country's HIV prevalence by half since 1992 to about 7 percent.

But Dr. Sam Okware, architect of the ABC plan and a senior Health Ministry official, said PEPFAR "shifted the emphasis to A and B just because of the amounts of money being put into these programs." Okware said the government has made the plan more equitable by using funds from other sources, including the World Bank, to promote condoms.

Dr. Mark Dybul, the U.S. deputy global AIDS coordinator, said PEPFAR supports all three components of ABC, noting that the number of U.S.-supplied condoms to Uganda has surged from 7 million to 47 million in the last five years. "Tough to argue we're pushing away from condoms in Uganda with numbers like that," Dybul said.

However, billboards urging condom use have disappeared from Kampala, and in their place are posters -- some funded by the United States -- urging youths to delay having sex until they marry.

Activists worry that the prevention message is becoming blurred, especially among youth. "Young people are confused," said Dr. Abeja Apunyo, country representative for the U.S.-based Pathfinders reproductive health group. "Of course I have no problem with the abstinence approach, but you have to be realistic and offer an alternative for different situations."

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