Uganda has taken steps to address the HIV threat posed when people have multiple sexual partners, but according to a recent study, campaigns to address the issue are having a limited impact.
"Analysis of the current communication environment in Uganda shows there is a range of - albeit limited - communication activity focusing on HIV prevention," said Peter Okubal, programmes director for the Eastern Africa office of the communications think-tank, PANOS, which conducted the study in 2009.
"Current MCP [multiple concurrent partnerships] policies, programmes and communication initiatives in Uganda are not addressing the social, cultural and economic issues that underlie why people engage in MCP," he added.
The PANOS study found that the only programme to directly raise awareness of the issue - the "One Love" campaign run by the Uganda Health Management Group (UHMG) - was limited in scope and did not address the drivers of the practice.
"The UHMG communication campaign is new and limited to Kampala city [Uganda's capital] and a few urban areas, [casting] doubt on sustainability of the impact on partner reduction," Okubal said. "Future attempts should incorporate an analysis of the social drivers of HIV; for example, messages about MCP are ineffective unless issues like domestic violence and stigma related to condom use and HIV testing are addressed."
The study - conducted in Kampala and the western district of Rakai through focus group discussions with communities, interviews with local leaders and reviews of existing documents on MCP - found that large billboards urging people to "get off the sexual network" had been removed after some months, limiting the continuity of the campaign's message.
Daudi Ochieng, head of communications at UHMG, agreed that the One Love campaign had a limited reach in rural areas, but blamed budgetary constraints.
"We had a very limited budget to roll out the campaign, so we looked at the most at-risk areas and decided to focus on urban areas as well as certain geographical locations that we found to be high risk, such as Kampala, [the northern town of] Gulu and the country's western region," he said.
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Ochieng noted that in other countries where the One Love campaign was being implemented, it was being executed as a five-year strategy but in Uganda, funding limitations meant the programme could only run for nine months.
The One Love campaign in Uganda was carried out in three phases starting in late 2009; the first phase introduced the public to the problem of "the sexual network" and its role in spreading HIV; the second phase aimed to show the effects, such as poverty and orphanhood.
In the third phase, UHMG focused on reducing HIV risk by helping couples make the most of their current relationships - by encouraging open communication and sex therapy, for instance - or using a condom in every risky sexual encounter.
"We are hoping for more funding so that we can expand and extend the programme. Right now we are moving it into a fourth phase, where we encourage people to get tested for HIV along with their partners," said Ochieng.
The PANOS study also found that the campaign did not resonate among the Muslim community, which rejected it due to the perception that it infringed on men's right to marry up to four wives.
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However, Ochieng said UHMG's own focus group discussions with Muslims found they agreed with the basic premise of the campaign, which urges partners not to have sex outside their established relationships.
PANOS discussions with communities and local leaders found that despite the existing challenges, most people were able to articulate clearly the definition of MCP and the role they played in the spread of HIV. Nevertheless, they felt the current messages on the issue were not sufficient to change people's behaviour.
"MCPs existed even before HIV. It is a big challenge in society because of cultural acceptance," said a key informant of the study. "Men engage in higher risky sexual behaviour than women and they don't mind whether married today, they will still abandon the bride and go in search of someone else. This is challenging communication experts on where to start in addressing MCP."