There is increasing evidence that for cultural reasons, women are unlikely to use condoms if their family planning method was satisfied through a long acting reversible contraceptive (LARC) and that women were more likely to have concurrent partners if the risk of pregnancy was so effectively removed with a LARC.

Uganda seemed very successful in reducing HIV infection with a strong message that AIDS kills. The ABC method of Abstinence, Be faithful and use Condoms seemed to work. People were so afraid of the disease and as every family lost relatives, the prevalence fell to 6.4%. But it has stagnated there and may be starting to rise. Money poured in from donors and about 200,000 Ugandans are now on antiretrovirals. Donors now seem to have had enough. They are saying that the message must be prevention, because although HIV can be treated, it is lifelong treatment and the money is not available to treat everyone.

In a male dominated continent where men prefer not to use condoms and women often do not feel empowered to then refuse sex, this is a worrying situation. It is made much more worrying if the belief is that the effect of becoming pregnant is much more serious than getting AIDS. 

Maybe the message will have to change back to AIDS KILLS.

Richard Feinmann is a 63 year old general and chest physician who retired a bit early after a serious health scare. He felt he had more to give and jumped at the chance to work with his health visitor wife in Uganda.