November 5, 2014
November 5, 2014
To prevent unplanned pregnancies and the spread of sexually transmitted diseases, nonprofit organizations and Makerere University in Kampala, Uganda, supply condoms to students through student leaders and peer educators.
KAMPALA, UGANDA – A 21-year-old student at Uganda’s Makerere University stands outside Lumumba Hall of Residence, where he lives.
It is a Friday evening and the student, Kwesiga, needs to get enough condoms to last him through the weekend, he says. He is waiting for a fellow student who distributes condoms at the university every day.
The second-year student, who declined to have his second name published to avoid ridicule from family and friends, says he has many sexual partners, mostly university students. Kwesiga uses free condoms supplied by the university to protect himself from sexually transmitted diseases and to avoid getting his partners pregnant.
Since entering the university a year and a half ago, the mass communications major has obtained at least three packets of condoms every weekend from peer educators in his residence hall. Each packet contains three condoms.
“I have had sexual encounters with many girls here in Makerere, and none of them has ever told me I made them pregnant,” he says. “This is because I use condoms.”
Students get the condoms for free from peer educators – students selected by Reproductive Health Uganda, a nonprofit family planning service, and trained to distribute them to peers. They also get them from elected student leaders and from condom dispensers put in bathrooms.
Before he joined the university, Kwesiga used to buy condoms at retail shops for 500 Ugandan shillings (20 cents) each, he says.
Many students his age are sexually active, and some have multiple sexual partners, Kwesiga says, making it important to provide ready access to condoms.
“Whenever I need condoms, I just go to a peer educator in my hall of residence and get some at no cost,” he says. “So I have a condom whenever I need one.”
Determined to curb the spread of sexually transmitted diseases and prevent unplanned pregnancies, nonprofit organizations and Makerere University are working together to increase students’ access to condoms.
Makerere University’s high incidences of sexually transmitted diseases and unplanned pregnancies prompted the administration to set up a reproductive health clinic and to begin distributing condoms in 2005, says Justine Kigongo, one of the university’s hospital’s counselors.
The program at Makerere University aims to reduce the pregnancy rate and decrease the spread of sexually transmitted diseases, including HIV, among students and throughout Uganda.
Among young, unmarried people in Uganda who are ages 15 to 24 when they have their first sexual encounters, 37 percent of females and 59 percent of males use condoms, according to a 2013 study published in the African Health Sciences Journal.
Among those who had more than one sexual partner in the past 12 months, just 31 percent of women and 19 percent of men reported using a condom during their last sexual intercourse, according to the Uganda Demographic and Health Survey 2011.
Consequently, Uganda’s teenage pregnancy rate is higher than those of its neighbors.
According to the 2011 survey, 24 percent of Ugandan girls and women get pregnant between the ages of 15 and 19. In Kenya, the rate is 18 percent, according to the Kenya Demographic and Health Survey 2008-2009. In Tanzania, it’s 23 percent, according to the country’s Demographic and Health Survey 2010.
Lack of reproductive health information is partly responsible for the high teenage pregnancy rates in Uganda, says Alex Kiwanuka, a youth officer in charge of Reproductive Health Uganda’s campaign to combat teenage pregnancy, which began in 2012. Furthermore, talking about sex is a taboo in Ugandan culture.
Only four in 10 Ugandans, 38 percent of women and 43 percent of men, have a comprehensive knowledge of HIV and AIDS prevention and transmission, according to Uganda’s 2011 survey.
Comprehensive knowledge means knowing that condom use and limiting sexual intercourse to one uninfected partner can prevent HIV, according to the survey. It also requires knowing that a healthy-looking person can have HIV, and rejecting common local misconceptions about HIV.
The low rates of condom use in Uganda contribute to high rates of sexually transmitted infections. In 2013, 63,000 people died of AIDS in the country, according to the United Nations.
HIV prevalence among Ugandans ages 15 to 49 increased from 6.4 percent in 2005 to 7.3 percent in 2011, according to the 2011 Uganda AIDS Indicator Survey.
HIV transmission is especially common among young people in the region.
An estimated 50 percent of all new HIV infections in sub-Saharan Africa occur in people ages 15 to 24, according to a 2010 published study in the Journal of Acquired Immune Deficiency Syndromes.
To counter these trends, the university hospital distributes about 360,000 condoms to Makerere University students annually through student leaders. The university has more than 10,000 students.
The supplies are sent monthly or bimonthly, depending on the need. Student leaders go for more condoms at the hospital when they run out of stock.
The Makerere University Hospital gets the condoms from the Straight Talk Foundation, the Ministry of Health and Reproductive Health Uganda. RHU also supplies condoms to students through peer educators.
Other nonprofit organizations, such as Programme for Accessible Health Communication and Education and the Uganda Health Marketing Group, distribute condoms every week by putting them in condom dispensers they have installed in residence hall bathrooms. They also provide condoms to the university hospital.
Under the Reproductive Health Uganda program, 30 peer educators have been trained to supply condoms to their fellow students since the program’s inception. They are trained for two weeks at RHU offices on reproductive health rights and safe sex. They are taught to maintain the confidentiality of those who obtain condoms from them.
Peers who distribute condoms at the university are not paid. During training, they receive a daily allowance of 100,000 shillings ($37).
The university has seen some evidence that the number of unplanned pregnancies on campus is declining, perhaps in part because of the condom distribution program.
The hospital used to record a pregnancy almost every week, says Ssewankambo Maureen, who has worked as a counselor at the university hospital since 1998. While the university’s student population has more than doubled since the 1990s, a pregnancy is now reported only about once a month, she says.
The program apparently also is helping to protect students from STIs. When Ssewankambo started working at the hospital, two to three students out of every 10 treated had sexually transmitted infections, a rate of about 25 to 30 percent.
In 2014, about 20 percent of treated students have had STIs, Kigongo says.
Peer educator Hassan Hussein sees the demand for condoms every day. He distributes about 10 to 15 packets of condoms a day from Monday to Thursday, he says. Each packet contains three condoms. He distributes many more from Friday to Sunday.
“I sometimes give out even 60 packets on each of those days,” he says.
A second-year student of social sciences, Hussein has been a peer educator for a year. Most of the students who obtain condoms from him are male, he says.
He adds that some students do not obtain condoms from peers because they want to keep their sex lives secret.
“Some students are sexually active but do not want other people to know, so they choose to buy from shops where they are not known or pick from anyplace where they can’t be seen,” he says.
Ignatius Birungi, 23, is one such student.
The third-year student at Makerere College of Business and Management Sciences, prefers to get condoms from condom dispensers in bathrooms to avoid being a subject of gossip, he says.
“We have free condoms put in toilets and bathrooms so that whoever wants them can get them without fear of being seen,” Birungi says.
The supply of free condoms has given young people a chance to avoid sexually transmitted infections, he says.
“I am sexually active but use condoms,” Birungi says. “Many of my agemates use condoms too. That way we avoid STIs and unwanted pregnancies.”
Geoffrey Tumwebaze, a 25-year-old student at Makerere College of Business and Management Sciences, also gets condoms from university bathrooms or buys from shops. He says he uses them frequently to avoid STIs.
“At a certain age, we are sexually active,” he says. “I don’t want to get AIDS, and I use condoms.”
Some students criticize organizations that distribute condoms at the university, saying they should preach abstinence instead.
First-year student Kim Kijjambu, 19, says the organizations should be advising students to delay sex until they get married.
“They tend to overemphasize condoms at the expense of other methods like abstinence that would help prevent unwanted pregnancies,” she says. “I am abstaining myself, and I am not dead. I have never fallen sick because I am not having sex.”
Kiwanuka counters her argument.
Churches are already preaching abstinence, he says, so doing the same thing would be duplicating interventions. Instead, the organizations focus on supplying condoms because condom use is known to be a key intervention in preventing diseases and unwanted pregnancies.
“You can’t deny the fact that they are sexually active,” he says.
Reproductive Health Uganda also provides other methods of contraception, such as implants, pills, injections and coils. It also screens for HIV, breast cancer and cervical cancer, and gives students information on sexual and reproductive health rights through the peer educators, videos and brochures, Kiwanuka says. RHU also sponsors talks at the university and provides information through videos and brochures.
The university hospital also teaches reproductive health, Kigongo confirms. It likewise provides other birth control methods and screens for HIV, cervical cancer and STIs.
However, the fact that a set of students leaves the university each year makes it difficult to measure the program’s impact, Kiwanuka says.
Reproductive Health Uganda plans to roll out its programs in other universities when it gets funds, Kiwanuka says. The organization is still writing proposals, so he is not sure when it will receive the funds.
RHU will supply more condoms through condom banks in bathrooms beginning in January 2015, Kiwanuka says. The banks will be restocked as demand requires.
Kigongo, the counselor at the university hospital, encourages student leaders to pick up condoms at the hospital whenever supplies run short at residence halls.
Kwesiga urges organizations supplying condoms to increase the supply so all students will have condoms when they need them.
“Regular supply of condoms in universities will save lives of many young people and reduce unwanted pregnancies,” he says as he walks to the peer educator’s room to pick up some condoms.