The country responded to the AIDS epidemic

UNAIDS
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and, in particular, among male military conscripts (a fairly representative sample of
men in their late teens since conscription in Thailand is primarily by lottery). Although
the programme did not explicitly aim to discourage commercial sex, increased risk
awareness apparently caused large numbers of men to avoid visits to sex workers.
The Ugandan lesson: changing social norms as a foundation for
behavioural change
Uganda’s experience provides a different perspective on the role of condom promotion
as a prevention intervention. The country responded to the AIDS epidemic with a
multisectoral approach backed by full commitment at all levels. The President and
other high-ranking government officials gave their support and leadership to these
efforts, and this helped to cultivate open discussion and involvement by all sectors of
society.
De-stigmatization and open communication were key aspects of the Ugandan response
to AIDS. Communication on sensitive topics was made easier as a result of public
disclosures by prominent Ugandans of their HIV-positive status early in the epidemic,
active support services for counselling and testing by a community organization, and
personal interactions with people living with HIV. The courage and willingness of the
Ugandan population to face the challenges of the AIDS crisis were evident in the fact
that a greater proportion of Ugandans compared with populations in other African
countries personally knew someone with HIV.
It would be wrong to conclude that condoms played no part in the Ugandan
experience, just as it would be wrong to say that condoms were entirely responsible
for Thailand’s success. Although the Ugandan Government never opposed condoms,
it did not place condoms in the top priority position in its HIV prevention messages.
Instead, prevention efforts focused on delaying sexual debut in young people, being
safer by being faithful to one’s partner (often referred to as ‘zero grazing’), and using
condoms—roughly in that order 6.
So why did HIV incidence rates fall in Uganda in the late 1980s and early 1990s? The
available evidence suggests that the main cause was a substantial change in sexual
behaviour and, particularly, a reduction in the number of non-regular sexual partners.
Simulation models confirm that the fall in HIV incidence in Uganda is consistent with
roughly 50% reduction in casual sex7. For example, in 1995, 26% of young men and 15%
of young women between 15 and 19 years of age reported having sex with a non-regular
partner in the previous 12 months, compared to 59% and 31% respectively in 1989.