South African Anti-HIV/AIDS Campaign ‘Misguided,’ Should Model Uganda’s Broad Focus on Changing Behaviors, Op-Ed Says
A South African advertising campaign encouraging safe sex is ineffective because it is vague and focuses on the individual, and should be replaced with direct and more society-based messages similar to those utilized in Uganda, Daniel Halperin and Brian Williams write in a Washington Post op-ed. Halperin, a faculty member at the University of California-San Francisco's Center for AIDS Prevention Studies and a visiting scientist at South Africa's Medical Research Council, and Williams, a South African public health researcher currently working for the World Health Organization, write that two years ago, South Africa's "loveLife" public education initiative was launched with about $100 million in funding mainly from the Kaiser Family Foundation, the Bill and Melinda Gates Foundation and the South African government. While the campaign's creators defend it as promoting "frank communication" and the "ability to make better choices" among young people, Halperin and William state that the campaign's messages are "confusingly vague" and "misguided" -- and that many South Africans are "outraged by the misallocation of precious public and private resources, especially when many community-based organizations are struggling to survive." The authors interviewed "several hundred" young people throughout South Africa, and found that while most were "obviously ... concerned, even obsessed" about the AIDS pandemic, "few ... showed any clear interest" in the loveLife initiative. One ad, for instance, which bears the words, "Score" and "Red Card" with check-off boxes next to them, elicited much talk about soccer rules before its intended reference to the dangers of obtaining HIV through unprotected sex was noticed. Williams and Halperin add that even though condoms "offer the best protection against" HIV and "most of loveLife's target population are not using condoms," loveLife's media campaign does not "explicitly mentio[n]" condoms.
The Ugandan Model
On the other hand, Uganda has employed a successful anti-HIV/AIDS campaign based on a "much broader" initiative that "emphasis[zes] a radical shift in community norms of sexual behavior, in contrast to loveLife's focus on changing individuals' decision-making capabilities," Williams and Halperin write. They state that Uganda has used strategies to encourage people to "delay sex," limit their number of sexual partners and increase condom use through a "broad mobilization of civic, religious and other grass-roots communities, combined with clear and committed political leadership aimed at changing fundamental patterns of sexual behavior." The success in Uganda, where the rate of pregnant women with HIV decreased from 21% in 1991 to less than 10% in 1998, demonstrates that "prevention policies can work," Halperin and William write.
Male Circumcision 'Ideal' Preventive Measure?
Halperin and Williams state that other "under-explored, potentially effective" HIV prevention techniques are "emerging," and one of the "more promising" is the promotion of male circumcision. More than 35 studies in the past two decades "have found that removal of the unusually vulnerable foreskin tissue reduces the risk of heterosexual HIV infection -- the most common form of transmission in Africa -- by a half or more." According to an estimate published in the Lancet last year, the procedure could have prevented eight million adult HIV infections in 15 African and Asian countries. Once abandoned by many African cultures, circumcision is gaining renewed interest on the continent, the authors write, more so for the belief that it is "cleaner" and enhances sex than for any HIV-prevention purposes. Male circumcision, "performed under clinical conditions," could "turn out be an ideal intervention," as it is a "onetime procedure for permanently reducing HIV/STD risk" and also is thought to make condom use easier. Noting that "billions of dollars" will flow into Africa in the coming years through the U.N.'s Global AIDS and Health Fund, Halperin and Williams write that "it is worth thinking hard about just how such sums will be spent" (Halperin/Williams, Washington Post, 8/26).