The major decline in HIV incidence

The major decline in HIV incidence clearly happened before large-scale condom
promotion was incorporated into HIV prevention efforts. Condom promotion was not
given greater emphasis in Uganda until the early 1990s. However, widespread debates
about condom promotion among political and religious leaders played a constructive
role early on in Uganda’s response to the epidemic because they encouraged people to
think and talk about AIDS. As controversy over condoms faded, the promotion and use
of condoms became generally accepted as a necessary component of HIV prevention
efforts. Social marketing of condoms got off the ground on a large scale in the mid-
1990s. The Ugandan Demographic and Health Survey (DHS) conducted in 2000–2001
showed that, among the 15–24-year-olds in Uganda who had non-cohabitating partners,
44% of the women and 62% of the men used condoms during their most recent sexual
interaction.
Overall rates of condom use were comparatively low at the time that incidence rates
began declining. However, even low levels of condom use in the overall population can
still make a difference as long as condom use is higher among those subgroups of the
population that are at highest risk. This may apply in Uganda, where condom use in
commercial sex was high8. Also, rates of condom use among young people, compared
to older adults in general, possibly contributed to the decreased HIV incidence observed
in that age group.