This article appears in the May 2004 edition of the Catholic Medical Quarterly

A Visit to Uganda

Peter Doherty

It was Churchill who first described Uganda as the 'Pearl of Africa' when he first visited it as a war correspondent before the Boer War. Without a doubt he was right for, although land locked, it is abundantly green and sitting as it does on Lake Victoria has a fascinating series of lakes from which the Nile emerges. It has great economic potential producing enormous quantities of coffee, tea and bananas and is at last beginning to recover from a tyrannical ruler.

The northern part is suffering at present from barbarities but the south is quite stable with its main evils being malaria and Aids. In South Africa they look upon Uganda as having made quite impressive advances against Aids but when one considers that out of a population of 25 million around 1 million are infected one is not so sure. The statistics which cannot always be relied upon are that South Africa has a prevalence of over 9% whereas the rate for Uganda is over 6%. Certainly progress but a week spent in a hospital leaves one looking hopefully for a patient or family that has not been affected.

The anti-aids programme is defined as, A for abstinence, B for behaviour change, and C for the use of condoms. With a sizable Christian minority some progress has been achieved with abstinence and a strong educational effort among the young population is certainly producing favourable results. Sex only within marriage. Behaviour change among the majority, in which tribal attitudes dominate, is less impressive. Among hospital patients it is not unusual to meet with whole families that have been destroyed. One particular case was a father who had 16 children from a series of wives, or co-wives as they are frequently called, the wives have already died and only four children have at present survived, with the father who is HIV positive. He was in the ward nursing one of his surviving children aged seven who is in a terminal condition.

Condoms, it is well recognised, are not popular with machismo males in Africa. It is also recognised that they only provide around 85% protection. Despite that, an announcement recently hailed that 3 million condoms were being sent to Uganda monthly by an American agency. An interesting portrayal of this aspect was recently made by a senior Ugandan health official in London at a meeting in which he described the Aids situation. On a table in front of the participants 15 glasses of champagne were placed with the proviso they were not to be drunk until the end of his talk. When he had completed his analysis he invited the audience to drink the champagne but warned them each glass contained a poison. A fitting illustration of the danger of the missing 15%!

There has been much debate regarding the spread of Aids; the lowering of immunity in Africa as a result of the elimination of smallpox, inadequate sterilisation of syringes, even to the extent of attributing it to a malign attack from the ex-Colonial powers. A cause frequently overlooked in African society is the effect of polygamy. There are many legal difficulties. Currently, under customary law, a girl at 16 years can get married. Under Islamic law, marriage can take place as early as 12 and 13 years provided the girl has reached puberty. However, the 1995 Uganda Constitution accords men and women of the age of 18 the right to marry and found a family. But many marriages are contracted with girls who are under age. Polygamy is defined as 'a marriage in which a man is married to more than one wife'. The key reasons for preference for polygamy are based on religion (Islam), tradition/culture, barrenness, there are more women than men, freedom and convenience. According to the Uganda National Household Survey (2002/3) the religious and cultural beliefs that support polygamy when unveiled reveal that the fundamental reason for polygamy is to satisfy the lust for illicit sex and a desire to subordinate and control women, regardless of the consequences and circumstances. Some women may enter polygamous unions because of economic vulnerability, ignorance and /or social stigma of singleness. Girls are often forced into polygamous unions against their will.

The Domestic Relations Bill recognises that marriages in Uganda shall be either monogamous or polygamous bur does not outlaw polygamy. It sets out requirements to be followed before marriages with subsequent wives can be contracted; a declaration has to be made that he is economically capable of supporting his wives and children, and has made provision for a separate matrimonial home for the subsequent wife and is capable of giving the same treatment to all the wives. The Koran too, states 'marry the women of your choice, two three or four; but if you fear that you shall not be able to deal justly with them, then only one that your right hand possess' but it does go on to say 'you will never be able to perfect justice between wives even if it is your ardent desire'.

It is evident that, as the Koran states, it is not possible to deal justly between all wives in a polygamous marriage, and since there are no positive benefits it should be banned. However, it would require a brave government to enact such a law. Rwanda, Burundi and Mauritius have already done so.

Meanwhile polygamy must be a major contributing factor to the spread of Aids.

Acknowledgements are made to Catherine Kanabahita Guma, Gender Advisor, Royal Netherlands Embassy in Uganda for many of the facts in this paper.