Appendix: Multilevel Timeline of Key Events International National (Uganda) Local (Masaka-Rakai area) 1978 • Alma Ata • Idi Amin invades Kagera Declaration: Salient, Tanzania, and “Health for all by provokes war. the year 2000.” 1979 • Idi Amin ousted. • Tanzanian troops respond to invasion, crossing into Uganda from Kagera. • Masaka town razed by Tanzanian troops— chaos, looting, and rape. 1980 1981 • World’s first • Civil War ongoing. published report of AIDS, in United States. 1982 • Civil War ongoing. • Eighty-four cases of Slim registered in Masaka’s Kitovu Hospital. 1983 • Virus that causes • Civil War ongoing. AIDS discovered by Luc • Anne Bailey speaks Montagnier—named in Kampala of an LAV. increase in Atypical • Recognition of AIDS in Kaposi’s sarcoma in Zaire. Zambia. 1984 • “Another” AIDS • Civil War ongoing. • November: first virus discovered by • Wilson Carswell official report of Slim in Robert Gallo— establishes that Rakai sent to Kampala, named HTLV-III. HTLV-III exists in no action taken. Uganda. • December: article about Slim in Rakai appears in the Star newspaper. (Continued) 188 APPENDIX: MULTILEVEL TIMELINE OF KEY EVENTS International National (Uganda) Local (Masaka-Rakai area) 1985 • Civil War ongoing. • February: • Slim the most common investigative team cause of death at from Ministry of Health Mulago national concludes that Slim is referral hospital in typhoid. Kampala. • October: seminal • Ten percent of article published in pregnant women the Lancet detailing Slim attending Mulago in Masaka. Slim and HTLV-III-positive. AIDS said to be different entities. 1986 • Consensus attained • January: Yoweri that LAV and Museveni takes HTLV-III are the power. same virus—renamed • June: blood screening HIV. begins in Nsambya Hospital, Kampala. • October: national Committee for the Prevention and Control of AIDS established (precursor to AIDS Control Programme). Concept of zero-grazing introduced. 1987 • Peter Piot argues • Donors’ conference • Kitovu Hospital starts for education as the held, $7.4 million screening blood for HIV. “main thrust” for pledged. AIDS control worldwide. • AZT approved by the U.S. Food and Drug Administration for use against HIV. 1988 • AIDS awareness pamphlets, badges, and stickers being distributed; condoms not promoted. • Twenty-five percent of pregnant women attending Mulago hospital HIV-positive. (Continued) APPENDIX: MULTILEVEL TIMELINE OF KEY EVENTS 189 International National (Uganda) Local (Masaka-Rakai area) • Headquarters established in Entebbe for UK-funded Medical Research Programme (MRC) on AIDS, and U.S.-funded Rakai Project. • The AIDS Support Organisation (TASO) founded in Kampala. 1989 • Uganda already • Ugandan singer Philly • MRC established in internationally Lutaaya publicly rural Masaka—HIV recognized for its open declares his HIV- prevalence estimated at AIDS policy. positive status. 8 percent. • International AIDS • National-level • TASO opens its second Conference in Montreal: recognition that office, in Masaka recognition that knowledge of AIDS hospital. most AIDS social does not always lead to and epidemiological behavior change. research in Africa • National Catholic is descriptive, with authorities confirm insufficient attention that condom use is to the evaluation of “unacceptable.” interventions. • Nationwide Demographic and Health Survey conducted. 1990 • International AIDS • Thirty-nine percent • HIV prevalence rates Conference in San of pregnant women in Rakai shown to vary Francisco: too much attending Mulago from 12 percent in rural research in Africa is HIV-positive; villages to 35 percent urban and convenience- 1.5 million Ugandans in main road trading based, ignoring heavily estimated to be centers. affected rural areas. infected with HIV. 1991 • Museveni speaks • Museveni agrees to of “apocalypse” at permit “quiet” condom International AIDS promotion. Conference in Florence. • Protector condoms • Trial begins in Mwanza, make their Ugandan Tanzania, to investigate debut, with a modest, effect of syndromic STD low-key advertising management on HIV campaign. incidence. • USAID grants $12 million for HIV prevention. (Continued) 190 APPENDIX: MULTILEVEL TIMELINE OF KEY EVENTS International National (Uganda) Local (Masaka-Rakai area) • First Antiretroviral drugs (ARVs) provided at Joint Clinical Research Centre (JCRC) in Kampala. • Forty-four percent of STD patients attending Mulago hospital are HIV-positive. 1992 • International NGOs • Uganda AIDS • Idea for Masaka release a Statement of Commission (UAC) Intervention Trial Belief, affirming their established. (MIT) conceived, to belief in the value and • HIV prevalence rates investigate the effect on effectiveness of behavior continue to rise at HIV incidence of (i) a change for reducing new surveillance sites behavioral intervention HIV infections. throughout the country. and (ii) syndromic STD • WHO study suggests Rates in provincial management. that 95 percent antenatal surveillance • Masaka reporting more of 559 research sites range from 7 clinical cases of AIDS projects identified percent in the east to 30 than any district outside in sub-Saharan percent in the southwest. Kampala. Africa were “of no immediate relevance to the local populations.” 1993 • World Bank’s World • $73 million World • Ninety percent of Development Report Bank-funded patients on Kitovu focuses on role of six-year STI Project Hospital medical wards health in economic starts. suffering from AIDS- development. • UAC: “a virtual related conditions. explosion of • MIT study design [AIDS research] finalized. activity” has taken place, but it is uncoordinated. 1994 • AIDS Control • MRC study in Programme (ACP) preparation for says there is a “noticeable MIT finds decline misconceptions in the rate of about, and opposition increase” in HIV to condoms. prevalence in most • Rakai project STD of the country’s mass treatment study sentinel surveillance starts. sites. (Continued) APPENDIX: MULTILEVEL TIMELINE OF KEY EVENTS 191 International National (Uganda) Local (Masaka-Rakai area) 1995 • Mwanza STD trial results • UAC: “there are no • MIT surveys and published: syndromic articulated national interventions start in STD management found policies on AIDS earnest. to reduce HIV incidence control.” by 42 percent. • First public suggestion of an overall decline in nationwide HIV prevalence. • Thirty-six percent of STD patients attending Mulago hospital are HIV-positive (down from 44 percent in 1991). • Nationwide Demographic and Health Survey conducted. • Median age for first sex found to be 16.3 among females and 17.3 among males. 1996 • Development of triple • Life Guard condoms combination ARV appear on the market: therapy, or Highly Active eight U.S. cents buy three Antiretroviral Therapy condoms. (HAART), for treating • JCRC treating AIDS. 1,000 patients with Antiretroviral therapy (ART); patients on HAART pay $1,000 per month. • HIV prevalence rates at antenatal surveillance sites throughout the country now range from 2 percent to 15 percent. 1997 • WHO Director General • Ugandan MP: “[A] Hiroshi Nakajima comprehensive set of warns that the new national [AIDS] policies ARV regimens could is yet to be generated.” draw policy makers’ • “Quiet” condom attention away from HIV promotion scrapped; prevention. open promotion now permitted. (Continued) 192 APPENDIX: MULTILEVEL TIMELINE OF KEY EVENTS International National (Uganda) Local (Masaka-Rakai area) • Twelve hundred registered agencies implementing AIDS- related activities in Uganda. • Uganda joins the Drug Access Initiative (DAI) to increase access to ARVs. 1998 • UNAIDS proclaims • Study finds national “Prevention works.” AIDS expenditure between 1989 and 1998 to be $180 million (= $1.80 per adult per year), of which 70 percent is covered by donors. 1999 • Controversial Life Guard • Rakai STD mass condom advertisement treatment study results appears, depicting fun published: no impact of and sexy lifestyle. intervention found. • Monthly cost of triple therapy has fallen to $500. • ACP estimates that 838,000 Ugandans have died from AIDS since the epidemic began. 2000 • Clinton administration • Median age for first • The number of condoms describes AIDS as a sex found to have sold through MIT in threat to U.S. national risen since 1995: the past four years is security and to global now 16.6 among females 1.5 million. stability. and 18.5 among males. • First indication of falling • International AIDS • HIV prevalence HIV incidence in any Conference in Durban: rates at antenatal part of Africa found Mandela urges drastic surveillance sites in MRC’s Kyamulibwa action to fight AIDS. throughout the general population country continue cohort. to fall. Now range from 1 percent to 12 percent. (Continued) APPENDIX: MULTILEVEL TIMELINE OF KEY EVENTS 193 International National (Uganda) Local (Masaka-Rakai area) 2001 • UN Special Session on • DAI transformed • Masaka district chairman HIV/AIDS (UNGASS) into a wider Vincent Ssempijja meets held. Accelerated Access Michael Weinstein, • In developing countries, Initiative. President of the 240,000 people receiving • Peter Mugyenyi U.S.-based AIDS ART. illegally imports Healthcare Foundation • Cipla decides to produce cheap generic ARVs and (AHF). generic ARVs, cutting forces the government to the cost of triple therapy permit importation of to $30 a month. the drugs. • MSF starts pilot ART • AHF holds conference project in Khayelitsha, on HIV care and support Cape Town. in Entebbe. Promises to open Uganda Cares ART clinic in Masaka. • Established