HIV Prevention Must Overcome Denial, Focus on Human Consequences of Disease, Health Journalist Says
Although public health campaigns that encourage youth to delay sexual intercourse or have fewer partners "remain vitally important" in the fight against AIDS, "to date, many HIV prevention programs in Africa have proven surprisingly unsuccessful," public health journalist Helen Epstein writes in the July 17 issue of the New York Review of Books. While "many public health experts have tended to regard HIV prevention in Africa as merely a technical problem," Epstein says that more may be required, such as "some shift within the minds of individual people and in the social atmosphere so that AIDS is recognized as the immediate threat that it is." In Uganda, however, AIDS prevention programs have proven successful, and experts attribute this to the "enlightened policies" of the government, governmental support for community-based AIDS organizations and an "unusually active" response to HIV/AIDS by "ordinary people." In addition, some research has shown that straight talk about sex and the effects of AIDS in local communities was the prime factor in convincing Ugandans to change their sexual behavior and stem the spread of the disease. Epstein says that while Ugandans are "not unusually compassionate people" and discrimination against those with AIDS persists, the country's stronger social networks may make them more likely than their counterparts in South Africa, where apartheid broke down many such networks, to talk more openly about these issues.
South Africa and loveLife
Uganda's success at reducing its HIV prevalence "has been hard to repeat in ... South Africa," Epstein says. Part of the problem lies in the "adversarial relationship" that the South African government has with many nongovernmental organizations, according to Epstein, which she argues "has almost certainly undermined efforts to prevent the spread of HIV." A group of public health experts in South Africa and the United States in 1998 created loveLife, a $20 million a year HIV-prevention campaign -- the "largest and most ambitious" HIV prevention program in South Africa -- that seeks to overcome the limitations of similar campaigns while avoiding the controversial issues of treatment and care. The South African government provides approximately 12% of loveLife's current annual budget. Major funding is provided by the Kaiser Family Foundation and the Bill & Melinda Gates Foundation. Additional funding is provided by the Nelson Mandela Foundation and UNICEF. LoveLife combines a sustained multimedia campaign including television, radio and billboards with youth friendly services in government clinics countrywide and a national network of recreation centers, known as Y-Centers, which facilitate a comprehensive approach to HIV prevention by offering youth activities, seminars and family planning and STD services through affiliated clinics to create a more "positive and cheerful" approach to AIDS prevention.
Using Sex To Sell Prevention
Through the advertising campaign, loveLife's creators seek to use the theme of sex commonly found in marketing and advertising to get people to think and talk about sex in a way that will make them realize the "virtues of abstinence, fidelity and the use of condoms," according to Epstein. However, while sex is openly confronted and discussed in all aspects of the campaign, the "experience of AIDS is not," and while the biological aspects of the disease are discussed, its effects on people's lives are not, Epstein says. One Y-Center GroundBreaker -- older youths who promote sexual restraint through leading loveLife seminars and discussion groups -- said, "We know that if we just came out and started lecturing them about AIDS they wouldn't listen. They would just turn off. So we talk about positive things, like making informed choices, sharing responsibility and positive sexuality." According to Epstein, the "striking and deeply mysterious" denial of AIDS in South Africa "has to be confronted," because "[o]vercoming such denial" may be what made the "greatest difference" in fighting AIDS in Uganda. And although "people like the colorful, frank advertising and the basketball games sponsored by loveLife ... its programs may be reinforcing the denial that poses so many obstacles to preventing HIV in the first place." Epstein concludes that a more realistic approach to HIV might pay "greater attention to the real circumstances in people's lives that make it hard for them to avoid infection" and could be more frank about the "real human consequences of the disease" (Epstein, New York Review of Books, 7/17).