Berkley Center

Background: Reverend Canon Sam Ruteikara is the Chair of the AIDS Faith Based Organization Self Coordinating Entity (SCE) and its representative on the Partnership Committee at Uganda AIDS Commission, as well a member of the Country Coordinating Mechanism (CCM) for the Global Fund. He is also the co-chair of the Uganda National AIDS Prevention Committee, chair of the AIDS Technical Working Group (TWG), and the chair for the Civil Society Inter Constituency Coordinating Committee (CICC). Previously, he was the executive secretary of the Uganda Network of AIDS Service Organizations (UNASO) and the chairman of the Friends of Canon Gideon Foundation (FOCAGIFO). He became interested in HIV/AIDS in the 1980s and has since worked with a variety of organizations that are focused on fighting HIV/AIDS. In this interview, Reverend Ruteikara shares his experiences from living in Uganda during the time when HIV/AIDS became a recognized pandemic.

You have recently retired after nearly 25 years as an Anglican priest. You have been an HIV/AIDS activist for almost as long as the disease has been known in Africa. Can you take us back, though, to your childhood? Where were you born?

I was born in 1947 in the southwestern part of this country, in Kabale District, which makes me come nearer to 62 years of life. I am the tenth of thirteen children. Six of us are male, the others are female. Now there are five remaining females, and six males. My father was a church person, what we call a catechist—a person who leads congregations. I grew up in the church, I liked the church, I liked singing, and participating in church activities. And so my mother wanted me to become a priest. Unfortunately she passed away before knowing that I was going to seminary, though my father was there when I was ordained in 1986. He passed away in 1994.

You have lived through tumultuous times for Uganda. Were you ever involved in any of the fighting around the regime changes?

I don't know whether I should say yes or say no. In 1971, I was kind of hunted down until I ran away from the country to Kenya. When Amin took over the government, we started hearing that they were arresting people who were working in intelligence for the previous government. At the time, I worked with Radio Uganda, the government broadcasting corporation. Apparently, that made me a target. They chased us around, saying that we were intelligence, those of us working in information.

The colleague I was working with, in my same unit, was arrested and killed. They tried to get him to work on military communications equipment, but somehow they killed him. I didn't wait to be next! Maybe they were not interested in me, I don't know.

I was a young man, alone, in Nairobi. My parents and others were in southern Uganda. In Nairobi I took a short course at the Bank of Baroda arranged for me from Kampala. When the course was finished I was posted to the Kampala Head Office branch, and so I came back quietly and nobody bothered me. I had stayed in Nairobi for six to seven months, and by July I was back in Kampala. 1973 I got married, and that's when I started raising my own family.

So, in 1978/79, when this war to remove Amin began, many of us were involved. We were involved in giving information. When Amin was removed, some of us who had suffered during the regime did military training, so that in the future we would not be held at ransom by gunmen. We didn't know to hold guns, we didn't know how to handle them. A number of us young people trained and got knowledge. But when they said “You should join the army,” I said, “No.” I didn't want to join the army and I did not want to put or keep a gun in my house; I wanted to go to seminary to become a priest.

What is your memory of the time before the upheaval of the Amin years?

From 1963 to 1971 or 1972 were good years. There was a lot of progress. A number of buildings in the city [Kampala] were being built. A lot of developments, factories, spinning mills, were coming up. The government built a number of hospitals around the country, 22 of them actually. Progress was very good. From 1972 to 1980 progress did not happen. In fact much of what had been built was destroyed during that time. A lot of things were destroyed. Hospitals were run down because doctors were killed and others ran away, even some of the hospital buildings were destroyed and, of course, there were no medicines. Even this hotel, then called Kampala International, was in shambles. Windows broken, doors not working, water system not working. Then, from 1981 to 85, things were beginning to build up again. Then the war of Museveni and Obote came, and a few things were destroyed, but not many. And then Museveni came in 1986 and the rebuilding started. But, comparing the 1960s and the Museveni regime now, less has come up in terms of new things. It is mostly repairing, renovation of old things. New ones are few especially in recent years. Some of them which were there have been completed. The Workers House, the Uganda House, Communications House—they had been there throughout the 1970s but could not be completed. So they remained as structures not yet completed. Not many new ones were built by the government. For instance, in the 1960s a lot of schools were built, new structures. These days completely new government schools are fewer, but there are quite many privately owned schools. We have built a number of universities, but they are all private. To me, as a person, there is a lot of progress, a lot of development going on. Compared to those days (the 1970s and 1980s) there are a lot of good things coming up: factories, office blocks, etc.

Let's go to the 1980s, thinking about HIV in Uganda. When did you first hear about HIV?

In 1979, we had a war to remove [then-President Idi] Amin. That war started in Tanzania and in the southern part of Uganda. It lasted up to 1980, it is over, Amin has gone, and in 1982 they started to see a few people sick in southern Uganda, on the shores of Lake Victoria. Actually the first two cases were identified at a place called Kasensero, a fishing landing site. There were mixed feelings. People were saying, “It is the Tanzanians causing the disease,” blaming it on people who came from Tanzania for the war, gun powder, etc.

Others said it was witchcraft. People were saying that there were some people from Uganda who went into Tanzania, stole some things, and so they had been bewitched. By 1983 there were many more cases. So people started talking, especially medical people in Mulago [Hospital, the main medical center in Kampala].

In 1984 to 85, when I was a student at the theological college, the conversation about HIV/AIDS was growing louder. One bishop said, “We should stop Holy Communion, because there is a disease that has come.” A few of us said, “No. We cannot simply stop Holy Communion because a disease has come. What is this disease?” And we started asking, we started reading. I wrote to the World Council of Churches and they sent me some information. The materials they sent were very correct, they were very nice. They still lacked a lot of information, but they had very good messages. They said you could not contract it by touching the cup, by handshake, things like that. But maybe what they said and what hasn't changed much is that when you catch it you are likely to die. There is no cure, there is no vaccine, and it is spreading very fast. The same message we are still using now, though we are adding a few things.

That was the time when I was finishing college, and as a new priest I was asked by the archbishop to write something about the disease. At that time they were preparing to go to London for the Lambeth Conference of 1988. By the time they had left I had not finished writing what they had asked me to write. When they went to London they didn't know that AIDS, per se, was in Uganda. When they were asked they said, “Oh, we don't know much about it. We think it is not there.” When they came back I gave the writing and the things I had gotten from WCC plus other studies I was doing in workshops.

In 1988 I was moved from a parish to prisons as a Chaplain. By 1991 I had qualified as a trainer of trainers with World Learning Inc., an American NGO (previously Experiment in International Learning, EIL) and so in August 1991 when a conference for Church of Uganda religious leaders on AIDS was organized, I was asked to head the facilitators' team. It was after this conference that I was moved from prisons to start an AIDS Desk in the Archbishop's office and later I started the HIV and AIDS program—it was my initiative with some help from friends like Fr (Canon) John Lathrop, a retired priest from California.

I started writing about the disease. One of my articles appeared in the magazine of the WCC, and then another appeared in a Methodist newsletter in the U.S. I participated in a WCC-sponsored HIV community appraisal here in Uganda. And so on. I kept doing a few things here and there. In 1991 I attended the first HIV/AIDS conference in Senegal, which is called ICASA (International Conference on AIDS and STDs in Africa). That was the sixth or the seventh of these conferences.

Initially, USAID was very hesitant to give money to the Church of Uganda for HIV. They went back and forth saying, “No, this is a faith organization, and the U.S. does not give money to faith organizations.” But they came to see that working with us was not only logical, but necessary because of our reach. They eventually said, “Let us give them money.” In 1992 they gave us money for prevention, and we began. When they gave us their money, they also gave to the Muslims, but the Muslims were not subjected to scrutiny like we were! Because they had agreed to give to us, it was easier to give to the Muslims, and for USAID the Islamic Medical Association of Uganda (IMAU) was more like an NGO than our CHUSA (Church Human Services AIDS Program), which was a church unit or department. Now many religious people are getting money. The Interreligious Council of Uganda is getting money. But, in those early days we fought and fought until we got something.

We got money in 1992 and ran a pilot program in five dioceses or ten districts of the country, and we also joined with the Episcopal Church in the USA to sensitize all the Anglican clergy in the country at that time. We went to every diocese and did conferences for all the clergy. We worked in five dioceses and did an extensive program. We evaluated in 1995/96, and we had done very good work. At that time, funding was changing from what it was to something else. Care and support was coming in, OVC was coming in. So in 1996 they didn't give us more money to continue with prevention. Since we didn't receive money, I had to leave for parish work and later in 1997 I went back to my prisons ministry. And then in 1997 to 1998 I went to the U.S. for one year, when I was at the Seaman's Church Institute of NY/NJ learning as an intern and sharing my chaplain's experience with chaplains who work with seafarers.

What were attitudes towards the disease in the early days, when word of it was just starting to get around?

There was a lot of misinformation. The church was saying, "This disease is not for us. We hear it is prostitutes, it is homosexuals, it is the promiscuous, it is the ‘sinners' and so, it is not in the church.” Because we had started learning a few things we said, “No, it is everybody. Even if these people are deviants in society, they are your children. They are your people. Even if they are none of that, they are members of your congregation. You cannot run away.”

The perception is that the Ugandan government got on board with HIV prevention relatively early. What is your recollection of the government's initial response?

In 1986, Museveni came to power. When he came to power, he sent some soldiers to be trained in Cuba. When they went, the Cuban government was already doing testing for HIV. When these soldiers went to Cuba, and were tested, a number of them were found to be HIV positive. The authorities there informed Museveni that, “Hey, the people you have sent are infected with HIV.” Then he started going around here, saying, “Hey, there is this disease, you have to be very careful.” Because the President was talking, the ministers also picked it up. The prime minister at that time was a medical doctor, so he also picked it up, and the government began to talk in a coordinated way around 1986/87. When the Church of Uganda started learning about it, in 1987/88, we started also talking. Because everyone, both faith people and the government, went into it, that's how we reduced the prevalence during the 1990s.

Let's talk a little bit about the progression of stigma around HIV/AIDS. At the very beginning, you said it was a disease of prostitutes and homosexuals. Is that what most people thought?

Yes. Most people—we are not talking about the whole country. We are talking about most people who knew. Most of them were religious people. They were the ones enlightened. Many of the people thought that that was the situation. That definitely created a lot of stigma. Why? Because people started moralizing, saying that infection was from immoral sexual practices. However, we began to learn that HIV is transmitted in three ways: sexual transmission, mother to child, and blood. If you remove blood, the remaining two involve sex. If you are infected, it means somehow you have been involved in sex—this also fueled the stigma. The science says the more the partners, the more the problems. This person must be having more partners. It started going like that. Statistics said that blood was accounting for less than two percent. The remaining sexual transmissions accounted for 98 percent. Each time they saw an infected person, people said, “It must be sex.” At that time, children born with the infection were not known to be so. The second point that became a problem was that, people who were infected, such as women, were told that they should not be pregnant. Because if you are pregnant you are likely to produce a child that is infected. People would say, “Ah, this person doesn't know what she is doing.”

Later on as we began to learn, they were saying, “If you are infected and you produce a baby, you should not breast feed.” People could not understand. “How do you produce a baby that you cannot breastfeed, unless you are a witch? You can't produce a baby and not breastfeed.” That one also became a problem. These issues continued in the minds of people. Up to today there are still people who point fingers and who blame and discriminate against people living with HIV and AIDS. For instance, Canon Gideon, who is an HIV positive priest, says, many times, when he goes to buy a condom, people say, “How can a priest go to buy condoms?” Even today there can be people who can't understand.

And then also, the Roman Catholic Church teaches against contraception. Condoms are part of prevention. So if we start talking about condoms for HIV prevention, we antagonize the Catholic Church. Up to today it is a point of contention. Last year, the Catholic Church was saying the country is wasting money to be buying condoms. The Catholics say, “They should stop and put money into other things.” People say, “No, condoms have been proved to work.”

I was asked to address a bigger conference on faith and condoms, perhaps in 1994 or 1995. It was quite a big event, and then I made a presentation. And then the audience debated, "Should we promote, should we talk about them? Should we discard them and forget about them? It was a big debate, you know?” Even among the others, there were those who support the Catholic thinking. The Muslims are split down the middle. They say condoms should be a last resort. If other things have failed, then perhaps you can use condoms.

When we started getting money in 1992, part of the conditions for getting those monies was to distribute condoms. When I wrote on my vehicle, “If you avoid sin, you can avoid AIDS,” USAID said, “No, no, no, rub that off.” They said, “Sin has nothing to do with AIDS.” I said, “It has!” But they made me rub it off.

By 2001, things must have changed a lot in terms of knowledge about HIV/AIDS.

Yes, quite a lot of things have changed. At that time, we were beginning to go into treatment, to put more money into care and support. I think it was 1998 when AZT was first available in Uganda. Around 1997 or 1998 there were even some fake drugs. One of them called Chemron, and was manufactured in Kenya. It was very expensive but didn't give relief. In 2001, we were beginning to go into treatment, care, and support.

In 1998, when [Canon] Gideon [Byamugisha] started getting treatment, the drugs were still very expensive. At that time treatment cost more than $1,000 per year, more than one million Ugandan shillings. In fact, Canon Gideon was getting medicine from USA from people who had actually died. They would be getting medicine, but some of them would pass away, and there would be a balance of the medicine. This medicine would be given to the Mildmay Center, and they would change it to give to Canon Gideon what he desired. These medicines would come through a lady called Cathy Watson and other friends.

That's when we started the fellowship for Canon Gideon, to continue fundraising and praying for him, and eventually we decided to make it an organization—the Friends of Canon Gideon Foundation. In 1995, when he started moving around and giving these talks, there was still a lot of stigma.

In 1988/89, when Philly Lutaya, a musician, came up and said he was infected, people said, “No, he is telling lies.” Lutaya was the first person in this country to admit he had HIV. He was living in Sweden, and he came back to Uganda, I think in 1988, and said he was HIV positive, and began making the film Born in Africa. I don't know whether you have heard of it? It's a very moving film, and they shot part of it here in the country. It was a struggle to allow him to do the film about AIDS here. But the vice-president got involved and so the film was shot. Soon after that he passed away, in 1990. But people, many people did not accept him. The stigma continued.

Many times we would not be allowed to talk in the church. Other times they would say, “Don't talk about AIDS things during our church service, talk about them after.” But because I was a priest many times I prevailed and had chances to talk. I can say that Uganda has succeeded in quite a big way in reducing stigma. People can move around and say that they are positive, they can form and join PHA clubs and associations, and they can get medicine and things like that.

When did medicines first become available for the average Ugandan?

It was recent. It could have been 2005 or 2006, when they started talking of giving some of the medicine free and having some of the clinics and health centers trained to distribute them. Up to today the whole country is not giving out ARVs because the Ministry of Health has to accredit clinics to give out ARVs. And then the medical practitioners need to be trained. And then there is need for counselors. And then there is need for machines, which are not yet many, for CD-4 count, for viral load testing, and all these kind of things. They are not all over the country, they are in different areas. Then there is the testing. Testing facilities are not in every part of the country. Sometimes people have to go a long distance to reach a testing center.

And then there is the problem of testing kits. Their stock is out, and they're told, “Oh, sorry, come next week.” And by next week they have changed their minds. What happens between now and next week? They are continuing to have sex. There are still complications about the whole thing. Secondly, we were giving ARVs to about 150,000 or 160,000 people. But by the end of 2007, people who needed ARVs were twice as many.

I wrote an article in the Washington Post and people here were angry with me. It was published on 30 June, 2008. Many people were angry with me, because in that article I said that there should be a balance between prevention and treatment. As you continue to treat, and others continue to be infected, you will never succeed, because the infected population will continue to increase. By now, you are treating less than half. And yet, today and tomorrow that number is increasing. Perhaps tomorrow, another 10 to 20 people will be added. What was half today (of those being treated) will be less than half tomorrow. Maybe in a few months it will be one-quarter. So if we could stop infection, and treat those already infected, perhaps we could get it into balance.

If your tap gets broken, and then you get all the mops, as many mops as you can find, you will mop forever unless you stop the water from the tap! If you allow it to continue pouring on the floor, you will mop forever. The people who criticized me said I was against treatment. They said I was talking ill of treatment. But I was not talking ill of treatment. I was trying to see how we can balance. So, that's what I'm saying. If we are giving half treatment, and yet other people are coming to need treatment every other day, we are not doing anything much. In fact, I was asked to write that article because I had commented on another article talking about Zambia. The article stated that Zambia was doing very well; they had put more than 100,000 on ARVs. I said, “No, don't even praise them. Because putting 100,000 when 200,000 are in need, and every day people are catching the disease, you are not doing much!” And so they said, “Why don't you write another, bigger article?” When it came out, oh! There was hell here. In fact, I can tell you, I am now being pushed out of these committees, the partnership committee. I understand there is a campaign behind this; people are telling me. In fact, soon, I will be out of the partnership committee. They think I am talking too much about these issues. About the truth. But some people are not interested in the truth.

I keep talking. I am trying to start my organization, a small NGO. I will keep using that, and I will keep talking.

That's how it is. As I said, the stigma is still there. Sometimes, you don't see the stigma in those terms. When I did that work at the headquarters of the Church of Uganda, my office was not allowed in the main building. There were small offices in the back, and they said, “The AIDS office can occupy those ones.” And you say, “Why?” They say, “Oh, the AIDS office needs more space. So you go in that one, the smaller, bad building. The good offices other people can occupy, and you, you need more space, so you go there.” It could be genuine. But in your mind you think it could be otherwise.

The AIDS program did not have an extension of the office telephone. They said, “The lines are over, so sorry, we can't give you an extension.” Fine, we'll use the direct line. Each time they call me, they yell, “Sam, you have a telephone call!” And I have to walk to the main building to talk on the phone.

You never know. They may not tell you that that is discrimination, but it may be. They may say, “Sam, you haven't been scheduled to preach for a long time.” It may be normal, because not everybody preaches every Sunday. But it could also be that they see me as that person doing HIV work. But we don't mind; we play it cool. There are still a few things that have continued to happen.

You have stayed with this issue for more than 20 years. Why have you remained so dedicated?

Because it is still fresh. AIDS still kills. AIDS still doesn't have a cure. AIDS still doesn't have a vaccine. AIDS is still infecting children who are innocent because they happen to have a mother that is infected. AIDS is still causing economic problems, when people have to leave school to nurse their sick, when people have to leave the city to move or relocate to the village where they were born. [When these children] go back to the village or rural place, there is no water running, no television, no good radio. And these children were used to those. All of these are issues that I sit down and think about and ask what can be done [about them]. [Through] that organization that I'm talking about…trying to establish, I'm trying to see how can I help young people who are not infected, but who would want to continue not to be infected. And [to] continue giving them support as they grow up. Because now nobody bothers about them. We are all bent on those who are positive. Nobody is talking about those who are negative, to keep them negative.

That is something that is on my mind all the time. How can I help these young people to remain negative? When I start the organization, when I get funding, that is the area that I want to go to. Can I bring them together once in a while, so that they can be strengthened by each other?

Also, secondly, something that taunts me in my head, when we tell younger people to abstain, and they grow up into adults, where do they go to get information to graduate from abstinence to sexual activity? There is nothing. Perhaps that is why HIV infection has moved from younger people to older people. Now, HIV among the younger people is quite low. But they won't abstain forever. They are [growing] up, they are adults, they want to be married and raise families or whatever. But who is now giving them information about what to do when they start sexual activity? There is nobody.

That is a difficult thing. Abstinence may be the right message for children and young teenagers, but as you get older, you need a new message.

You need a new message. A message that may be even more sensitive to their changing needs. Someone would say, “I want to get married. But I don't know about these issues of sex, what do I do?”

Nobody is willing to answer that question. I talk to clergy many times, and they are not willing to answer that question. They talk of other things. Perhaps these people are going into sexual activity ill-informed. They are [making] a few mistakes here and there, and now the infection is so high among the married in this country and maybe a few other countries. Who can help these young people to prepare themselves for marriage? Who can begin now to intervene among the married, so that we begin to bring them together and talk with them? You will see what I'm thinking about. These are the things that keep bothering me, and keep me going [on] these HIV/AIDS issues.

Recently, I met someone I used to work with, and this person exclaimed, “Oh Sam, you are still doing HIV/AIDS, my goodness!” Yeah, I'm still doing it.

Talk a little bit about faith, and your own faith, and how it fits into your HIV/AIDS ministry, and how it has informed and motivated what you have done.

It's only because many people don't understand. As we continue, perhaps some will. Faith is the best tool that can help us in HIV/AIDS. One, if we fear God as we are supposed to fear God, then that would help us to act in a certain way, and that way would be protective, if we carry out the commandments, to love thy neighbor and thyself. All those things would help us to behave with our fellow people in such a way that we [wouldn't] infect them and they [wouldn't] infect us. Two, if we followed the faith teachings, both [in] the Qur'an and the other teachings, they have got scriptures that tell us how to deal with issues of this nature. But we don't follow them properly. Perhaps we don't teach them properly. That is another area that is so motivating.

Three, is what I think I said yesterday. As you deal with faith, please don't deal with it outside of scientific knowledge. Get faith teaching, couple it with scientific facts, and then you are in a good position. We need to get facts, which I now have, and faith, which I also have, and join them together. For instance, we talk about condoms. What can we say, given faith teaching, and what science teaches? How can we deal with it?

Four, the religious institutions are the only institutions with respected leaders in some communities from the grassroots to the national level. [When] the bishop talks, very many people will listen. [When] the priest talks, many will listen. How are we using these people to be able to change people, to motivate them, to give them messages, even to give them services? [The] Church of Uganda has nearly 50,000 congregations in this country, about 50,000 when we last did the census. If we told the archbishop of the Church of Uganda that this message should go to every congregation, and he accept[ed] and gave it to be conveyed to every congregation, imagine how many people in this country would hear that message. What if we joined [the] Church of Uganda and the Catholic Church? What if we joined the Church of Uganda and the Catholic Church and the Muslims? Every person in this country would hear.

But are we using these structures correctly and effectively, so that we can give information and services to the people? Perhaps yes, perhaps no. [As a priest] I know that… the congregations are underutilized; they are not given these messages. For instance, if they said, every priest should organize people, and we [came] and test[ed] them at the church, the whole country would [be tested]. We have tried it here in Kampala and it worked! In two or three parishes, people lined up, and testing kits got finished. A lot of people, even from the community around, came. Why can't we do it regularly? It is not organized in such a way.

Lastly, faith teaches what we call self-control, free will. How are we using it to capitalize on issues of HIV/AIDS, so that we raise up the self-esteem, the self-worth, and the self-control of the people, so that they can begin to use themselves to prevent AIDS? I'll give an example. Some people say, “Men cannot only have one wife. Their sexual desire is so much that they cannot have only one.” Is that true? Is that not true? Can they control their sexual urge? Or is it beyond their control? These things can be studied and we can find out. If we find they cannot control, then perhaps we learn how to deal with those men. If they can control, then we motivate them and support them to use their self-control. And then, perhaps it will help. If people were using their knowledge and their will, perhaps a lot of things would be changed. Somebody sits here and says, “OK, I'll go tomorrow evening and sell sex.” That is some decision that is being taken. Perhaps if that person is given other information, the decision may be different.

In that case—nobody wants to sell sex. But in some cases, aren't people forced to do it by situation?

They are forced by situation. But the situation is based on certain information. If the information is different, the decision may be different.

Aren't there some women with no other opportunities, who feel they have no choice?

That's what I'm saying, if they have no alternatives, they have no options to choose from, then they will decide whichever way [makes the most sense]. But if they were given options, they would perhaps choose differently, because people have choice. They can decide to sell or to not to sell. They can decide to continue selling or not continue to sell. It has happened that people have left prostitution and said, “No more,” because of certain things that have happened, or because of information they have received. And they have stopped. If there was a way of opening up these options, perhaps different people would make different choices. They have the ability to do that, but the ability needs to be supported with information and, sometimes, with support.

I have always given an example. I go to a seminar and teach about condom use, and I say, “This is very good,” [and a man says], “I have brought five condoms, and I want us to start using,” and the wife says, “No.” What do I do next? The workshop is over, the wife doesn't want, [the man] throws them away. But if [the man] can get information from somebody else, then [he can] next try again, [and the man can be given] some negotiation skills. “If you want to convince her, say this and say this, this kind of thing.” And when the five get finished, [the man will] know where to get another five. [But, the man may not] have money to buy them from a shop. There is information, and there [are] also supporting services that can keep supplying the needed materials or can keep giving support to continue doing whatever [people] are doing. Somebody wants to stop drinking alcohol. And then he stops for two days, and nobody says, “Please continue stopping,” and he looks around and says, “Let me take another one bottle, and at least that way I will stop.” But if he can continue getting support, and other things to do, perhaps fellowships or meetings, then he can change his way to something else.

Perhaps you ask someone to stop prostitution. But what if it was the only way to get income? What are you saying, you starve and die? There must be an alternative. You can do some useful things and get some money here and there. We as faith people, we sometimes say, “Don't continue selling alcohol.” Some people [get] their income by selling alcohol. And we say, “That's not good. You have a family, you have children, now you are selling alcohol in your house.” But they say, “If I stop selling alcohol, what will my children eat?”

What do you tell them?

Sometimes that is difficult. Because you can't have everyone come to church to get an income or whatever; you have to look at many other options. Perhaps, instead of selling alcohol you can sell bananas, you can sell ground-nuts. These are options. And then once the person is convinced, they can take the decision. All of these are issues [that] need to be taken up. To be taken up, people need to believe in them. I believe in them because I am a person of faith. I know if I follow what God teaches, I'm likely to behave differently. Some people say, “Nonsense, those things are difficult. It is impossible to abstain.” No, it is not impossible! There are people who have abstained.

All of these things, there is need to persist [in] them. And these are things that keep me going. I believe in them, I have some convictions.

I told the American ambassador, Jimmy Kolker, to look around the city, because there are tens of billboards promoting Protector condoms, Lifeguard condoms. And yet the strategy is ABC. C has got 10 billboards. Where are the billboards of A and B?

And he went to Washington, and told somebody, “Sam thinks that if we put up a few billboards of abstinence, perhaps that would be OK.” This other person told me that, “Is that what you said?” I said, “No! That is not what I said, to balance [just] the billboards, no.” I am saying that since the strategy is ABC, [we should] equitably balance each part. [Condoms] need purchasing, need transportation, need storage, and need distribution. Abstinence needs none of these, but it needs advocacy, it needs talking about. If you compare the monies needed for the C and for the A, A would need very little money. The same as B. But we don't do things that way, we don't balance, we don't equitably give the services. C has got a distribution policy. A and B have no policy at all in this country. Why don't we, just for the sake of it, make a policy that gives ABC, because ABC is accepted in this country as a strategy. I know Canon Gideon doesn't accept it. It is given as a strategy in this country, so why don't you, for the sake of it, say this [ABC] is the policy?

No, I don't need a few billboards, I need a policy that can equitably deal with A and B and C.

In the U.S., HIV/AIDS was initially thought to be a disease of homosexuals and intravenous drug users. Was it initially thought to be associated with these groups in Uganda?

Yes, yes. The information we got at first was saying that. A lot of cases in San Francisco [were] being found among the homosexuals and so on and so forth, and the intravenous drug users, and that [seemed to be] where the main problem [was]. People here [were] saying, “There is no homosexual problem here. There are no intravenous drugs here, so this thing is for Americans, it is not for us. No, don't bother us. Even if there may be a few homosexuals here, that is not a big deal.”

At an international AIDS conference in Germany in 1993 or 1994, a Ugandan was asked, “In your presentation, you have not made any comment about homosexuality. Why?” And she said, “No, I didn't make any comment, because homosexuality is not a problem in Uganda.”

She was asked, “You call homosexuality a problem?” She said, “Yeah, it is not a problem for us.” Oh my goodness, the conference got into chaos! “How can you say homosexuality is a problem? It is a way of life!” There was shouting, and that session got disorganized, but eventually it cooled down. We said, “Sorry, it is the conception, it is the language problem. She wanted to say, ‘It's not an issue, it's not something that's happening a lot.' She didn't want to say that it was equivalent to a problem.”

In this country, homosexuality and prostitution are illegal practices. But yet, we think, those of us who are HIV/AIDS activists, think there should be an intervention to help the sex workers and the homosexuals. Do you think the government will say that that's OK? How can you do it? How can you write a program to intervene in illegal practices? It's a dilemma. You look into our documents, and you'll see commercial sex workers, and men who have sex with men. How do you, in a national Ugandan document, put interventions for dealing with illegal practices? It becomes a problem. It is like saying, “We know there are thieves, but we want to collect all the thieves and work with them.” If you know the thieves, you should arrest them!

These are issues. We have to continue thinking, how can we deal with people who are doing illegal things. But if we don't deal with them, they will spill over into people doing legal things--[then] what do we do?

People are doing abortion. Abortion in this country is illegal. But after abortion complications, you need interventions. When a person comes with complications and problems of abortion, [and I am] a doctor, what should I do? Should I deal with it? Should I stop? Would that be unethical? Am I abetting, am I condoning? These are complicated situations, but we have to continue looking for solutions to deal with them.

Within the community of faith AIDS activists, the people you consider your peers, do you think people are thinking about it as you are? That MSM is something we need to deal with, but is very difficult to address because of the illegality?

Definitely there is a divide. There are those who say, “These are immoral things, and nobody should be talking about them.” And there are others who say, “Yeah, immoral as they are, if we don't deal with them and allow them to continue unintervened with, they will spill over.” Because some of the homosexuals are bisexual, they go to this one and then they come back to their heterosexual spouses. Now, what do we do? They will keep getting and bringing into the family. The same as prostitution. Many of them have got spouses. Somebody said, these people may have families, but what do we do, if we don't intervene? But to intervene is to do something among illegal entities.

Wanted or unwanted, they must remain alive. And that's my job, to keep them alive. All those kinds of things are issues that people should begin to think about. I may not get an answer during my lifetime, but answers someday, somehow, must be found. But something must be done. If we don't do it, it may continue to be a problem even to the others who are legal entities.

There are many places where HIV prevalence is declining. But there is some evidence that the epidemic is in full force in some special populations, such as MSM, which suggests that if those populations are not addressed, then overall progress will be hindered.

Yes, though in different countries, there are different situations. There are countries where these special populations are significant. Therefore, dealing with them is a must. There are other countries where the situation, like Uganda, the HIV is in the general population. The situational populations are insignificant. But they must be dealt with somehow. Where they are significant they must be dealt with, otherwise they will spill over. Where they are not very significant, that's where you need to begin to think, “What do we do with them?” If we allow them to continue, then by the time we realize, they [will be] too much to [deal] with. So what do we do?

The day before yesterday, a law was tabled in parliament to criminalize homosexuality. If they catch you doing homosexuality, then you can be arrested. And there will be procedures of taking that person to court, and then they'll be judged according to this law. But now it says, that it is not allowed, and that is all. When you do it, you are against the law. But when you catch me doing it, what are you going to charge me with? With doing homosexuality? Or being indecent? In fact, prostitutes in this country, when they are arrested, are charged with being idle and disorderly. There is no law specifically criminalizing prostitution. When they arrest them, they are charged with being idle and disorderly. Being idle and disorderly attracts a very small fine. So they raise up a little money, pay it off, and go back in the street. Alternatively, with the police suffering from poverty or whatever, perhaps they give a small fee to the police people so they don't arrest them. Alternatively, they [may] give sexual favors to the arresting authority.

When the law is eventually passed, how are we going to go about implementing it? Perhaps there will be provisions in the law to say what to do. How do we enforce? You see, one of the problems with HIV/AIDS is enforcement. When people go into their bedrooms and close the doors, we don't know what happens. And so, they come out, and one is positive and one is negative. What is happening? Are they sleeping together? Are they sleeping on different beds? Because I know a relative of my wife. When the husband came home and looked sick. The wife said, “Oh, there is this disease, I will not sleep with you.” She refused. And the man died, and she is still there because she refused. He was working on the border at the customs office. When he came, he looked sick. She said, “You are going to bring disease, I won't sleep with you.”

The woman is still there, keeping the family. So, what happens among people's homes and houses and bedrooms, we don't know. Maybe others are being infected against their will. Maybe others are ignorant. Maybe there is a problem of disclosure. Maybe people don't disclose their status. Perhaps the woman has tested, and the husband has tested. They know their status, but they have not shared. Each of them is hiding. Maybe both of them are positive. Or maybe both of them are negative, but they [afraid] to say, “I have taken a test.”

We used to say, [although] it may not be true, [but there seems to be] some truth in it, [that] some people go and test, and they get a negative result, and they go to celebrate that evening, and get infected. They ring the girlfriend. And they get infected. In between the testing, one of them gets infected. These are issues that are complicating the issue of AIDS. We cannot deal with them all. We can deal with some of them, butwe want to continue thinking about all of them.

Let's talk, for a minute, about Uganda's economic challenges. Uganda, as we have said, has had rough times for quite some time. In the rural areas it has always been difficult. Does this moment mean anything different?

I don't think it means anything different. Many people are not going to know that there is now a difference. They are going to know it is the usual problems they have faced. It may be hard[er], but it is the same thing. In this country, the general trend has been the rich becoming more rich, and the poor becoming more poor. And this has continued for some time.

To me, I think it comes all out of the Amin period—the 1970s. Out of that, we have never recovered completely. During Amin's time, people kind of tried to live. No sugar, no salt, no fuel. Since that time we have not gone back to normal [as it was in] the 1960s, where as a young man just starting to work, I would wake up at midnight and go to the nearest shop and get what I wanted and it [was] cheap enough and so on. Yes, the newest shopping mall is going to be working 24 hours, but it is one in Kampala. We are not going back to that level. Secondly, because of the destruction of factories and other things, [there] has not been enough work. We don't have enough facilities to employ most of the people. There are less and less institutions to employ people. There is still movement from rural to urban. As they fail to get work and other livelihoods, they become some kind of thieves. That also is always there. If you look around Kampala, you will see that the slums are not dying off. They are continuing to [make] shanty structures, more and more. I think it is not Museveni's making; it is something that has developed slowly, but has not yet been overcome by the developments that are there.

Putting a child in secondary school [costs] about $3,000 a year—the food, the uniform, the shoes. It is something, two to three million [shillings] in a year. And [people] do not have that. It is very complicated. How people raise money, I don't know. Of course there are some schools that are cheaper. But those schools are poor in standards. I'm saying this because I know; I see the children [of my relatives, my people] dropping out of school. When I ask, the child says, I need 300,000 shillings to go back to school. If there is no more money, or [if there is] plenty of money, such people are going to continue experiencing those difficulties. Putting up a small house costs millions of shillings.

Even if foreign aid money is reduced, people will not notice, because NGOs don't give to everybody. Once the NGO goes away—well, they have always come and gone. I don't think most people understand and feel the effect. I have a brother: he is the one who lives in our homestead in the village. My other brothers have bought homesteads in other places. But he doesn't have any particular income at all. He doesn't work. He gets money by selling agricultural produce. Things like that. If the dollar goes up, or goes down, he will still get some little money, from his avocadoes or something like that. I don't think he quickly goes into relating his little money with economic crisis in America or Europe.

For us, for the few of us, we may feel the pinch. Or, if people are receiving some dollars, they are getting less dollars, getting less commodities out of it. If a man has been getting some money out of his children living abroad, he may know and say, “I'm not getting what I've been used to getting.” Whether he may relate it to the credit crunch, I do not know. Me, in particular, I may not feel much, because I no longer work.

If it is someone a little farther from town, they may not feel the difference. If the children continue to give them support, they may not know whether or not their children are going through more difficulties in getting income, or if [the children] stop the support, the parents blame the children and not the economic crisis.

From what I have heard, people are saying, "Tell us about our own government." They are not giving what they are supposed to give us. Don't talk about what is happening in the world. Our leaders are not giving what they are supposed to give us. They have diverted from God's ways, they could give us what we are supposed to get. It is not the world economy. It is our leaders who are misusing what is supposed to come to us. I heard many people saying the same thing. It is coming back to God. We should say, “Come back to God's ways!” And things will begin to be better. Don't tell us what is happening worldwide in the economy. If things are done better here, they will relate better and be OK. That's what I think. The general population may not quickly relate to that.

Secondly, our president has said that this world economic problem can be an opportunity for people in Uganda: “You people have got land, you can produce some food. Because food is now scarce, it is costing [more]. Can you do that, quickly? Can you get things out of your soil and sell?” And so, perhaps, people are saying, instead of crying about the world economy, we can use it, and get something. Perhaps that is another part of the population. I haven't heard that. It is me now who is saying that. I don't know if some people in the population have agreed to the same kind of thought. They are not seeing it from the bad side. Perhaps they are now looking [at] the opportunity side. You have your fruits, fruits which you don't need to plant, and the trees are going to put on fruit. All you need is to care for the fruits, and you are going to get a little bit more because they are scarce and people are going to pay more for them. That's another argument.

Do you think you and Gideon have helped each other become more effective?

Yes, yes. That's why he calls me “Dad.” I trained him. And, that is very very good and marvelous work he is doing. Many times I feel a little bit of satisfaction, because I contributed to it. As I was saying yesterday, there [was] a time when he was not very strong, and he asked me to keep making those appointments for him. Those in New York, or [at] the World Bank, and I was doing it on his behalf. Then there was a time when he was not feeling well, and yet he had an assignment in Ethiopia. He said, “Uncle, can we go together? You can speak more, but I'll be there also.” We went together also. We have supported each other. It's only in recent times that we don't agree specifically on ABC and SAVE. For me, I say that SAVE should be in addition to ABC. Canon Gideon thinks that SAVE should replace ABC. So we don't agree. But [that is] no problem. We are all doing the same thing. We are minimizing the disagreement. ABC may have some shortcomings. But it has worked. If it has stopped being effective, the answer is not to discard it. It is to improve it.