Prevention of AIDS in South Africa

Prevention of AIDS in South AfricaPaul R. EarlFacultad de Ciencias BiológicasUniversidad Autónoma de Nuevo LeónSan Nicolás, NL 66451, Mexico

South Africa, population about 43 million, needs a set of indicators that can be used to track national responses to the AIDS epidemic. AIDS stands for acquired immunodeficiency syndrome which is caused by Human Immunodeficiency Virus (HIV). Not only are infections by HIV tracked by its antibodies, Western blot and reverse polymerase chain reaction (RPCR), but also changes in the attitude, social values, health care practices and counselling, condom availability and acceptance, socioeconomic conditions and sexual behaviors that act as predisposing factors of the epidemic are duely noted, including abuse of women, human rights and the acceptance of AIDS victims by the community.

Pathways to Action by Kelley et al (2000) is found extremely useful and available via Acrobar Reader at the Cadre websiteBehavioral changes via advertising with most credit going to Soul City programs is an important theme.The time of man as warrior-hunter-foodgatherer has passed, changing the very long history of female dependence, but African cultural beliefs remain. In the tradition. Women are then subject to every abuse from rape to child prostitution.She may not be able in her bedroom to negotiate the use of a condom.

Protocols for diagnosing AIDS.Attitudes towards voluntary testing and counselling are mediated by the notion that AIDS is a fatal condition, thus there is “no point in being tested.” Then it is important to expand information on the potential to extend life through the application of antiretroviral drugs. Regardless, the silent cases remain undisclosed. However, 30-70 % of people develop an acute retroviral syndrome with fever and lymphadenopathy in 2-4 weeks after HIV infection.

The serological test ELISA is the best available for screening because of its low initial cost of about $2 per test for reagents, standardization, high reliability and fast results. Western blot with the identification of specific protein bands is the most commonly used and most respected supplemental test. Compared to the ELISA test, it is much more expensive, takes longer time to perform, requires greater technical precision and is more difficult to interpret. The total cost of performing a Western blot test is about $40.

Getting the condom message across.The main issue might be: What proportion of primary school graduates have a complete knowledge of HIV transmission? A high level of HIV/AIDS knowledge has existed for more than a decade, at least in cities. Does knowledge of itself bring about desired behavior ?The ONLY way to reduce the epidemic is by use of condoms.

The main fact is that condoms prevent HIV transmission and unwanted pregnancies.

The effective use of the mass media is the critical factor in HIV/AIDS prevention.

Condom acquisition and use.Condom use depends on the discrete and non-judgemental access to condoms in each locality, especially for teenagers. The most nationally representative survey on condom use was the South African Demographic Health Survey conducted in 1998 with 854 subjects 15-19 year olds. Of these 19.5% reported using a condom in the last sexual act with any partner, and 21.2% with a nonspouse partner. Consistent condom use ranged from 20-30 % in rural areas to as high as 70-80% in cities.

Rates of young people never having used a condom vary substantially, ranging from 60% in remote rural areas to only 14% amongst privileged urban youth.Condom use positively correlates with education levels.Condom use is associated more strongly with pregnancy prevention thanwith HIV/AIDS and STD prevention in some studies.

Communications campaigns. A wide range of communication campaigns have been conducted in South Africa to raise awareness about AIDS and to bring about HIV preventive practices amongst young people. National HIV/AIDS communi-cations approaches have included both single media and multimedia approaches including:Television advertising, for example, the Beyond Awareness Campaign’spromotion of the federal AIDS Helpline, Soul City’s promotion of HIV/AIDS issues;and the Society for Family Health’s condom advertisements.

Radio advertising, print advertising in newspapers and magazines, outdoor advertising, including billboards and signage and extending to mobile media such as commuter taxis, buses and trains. Various campaigns including the Beyond Awareness Campaign, and the loveLife campaign have made these shows prominent. The “brand” can be loveLife, and then the payoff line is: “Talk about it.”

Drama centering on AIDS

Print supplements are often used, typically involving the insertion of magazine format publications into national newspapers for dissemination. Soul City and loveLife have used this approach.Small media approaches, including leaflets, posters, booklets and branded utility items, with the widest use being by the Beyond Awareness Campaign.This was incorporated in the development of a national AIDS Action Office--a clearinghouse facility which allowed organizations and individuals to order free HIV/AIDS materials.

The Beyond Awareness Campaign was a multimedia and multiactivity HIV/AIDS campaign of the South African Department of Health targeting youth in the 15-30 year age group. The objectives included:1/ Intensifying communication of key messages around HIV/AIDS;2/ Promotion of the red ribbon as a symbol of willingness to help in HIV/AIDS;3/ Development and promotion of the national tollfree AIDS Helpline;4/ Development and dissemination of small media communications resourcesthat support action around HIV/AIDS;

Running parallel to school-based initiatives, a number of organizations involved in HIV/AIDS prevention have initiated a range of activities broadly grouped around the idea of youth development, which in various ways have set out to teach young people lifeskills. However most programs are small-scale. Prominent among these is Stepping Stones and DramAidE, both of which have specific foci on HIV/AIDS, but which also focus on gender issues and communication skills more generally.

Stepping Stones behavioral intervention was developed in 1995, and has received strong international acclaim. It has been used throughout subSaharan Africa and has been translated into a number of languages. The approach wasdeveloped in Uganda. It focuses on preventing HIV infection through transforming gender relations and through lifeskills learning. Selfefficacy and empowerment in a number of specific areas are the goals.

Key features of Stepping Stones include:-A focus on all sections of the community, rather than specifically high risk groups;-A focus on axes of difference in communities, especially gender and age;-Use of participation methods which are enjoyable and empowering;-Recognition of the needs and priorities of participants as its starting point, and all work beginning with participants’ own experiences and contexts;-Recognition of the idea that the best solutions are sometimes generated by people themselves rather than suggested from the outside;-Design that enables the exploration and negotiation necessary for communities to address and change social norms.

DramAidE is another initiative in the area of lifeskills development. The organization has been in existence since the early 1990s and is based at the University of Zululand and Natal in Durban. The organization has pioneered a culturally sensitive approach to lifeskills and HIV/AIDS education.A strong emphasis is placed on understanding the lives and circumstances of learners through encouraging them to express themselves creatively through drama, theatre, song, dance and the visual arts.

Drama has played a prominent part in South African AIDS education, as has puppetry. Drama has proved to be a useful feature for creating a lively, entertaining, engaging context in which to explore AIDS issues. Role-play and participatory drama methodologies allow people to enter into understanding issues in ways that are personal and localized. These methods can translate abstract issues into the language of experience.

A third youth-oriented development program is President’s Award – a largescale life orientation and skills development program, which has grownexponentially in South Africa and is currently being implemented in other partsof the continent. It is orienting around AIDS issues especially in its young offenders program, but also in its general youth development program.Reports of “always” using condoms increased with increased exposure to SC: 6% of quiz respondents with no exposure to SC reported “always” using condoms, whereas 16, 30 and 38% with exposure to 1, 2 and 3 sources of SC respectively reported that they “always” used condoms. Consistent use means using a condom every time you have vaginal, oral or anal sex—from start to finish.

The National Progressive Primary Health Care Network has produced a series of pamphlets called ‘Let’s teach about AIDS.’ Soul City and Planned Parenthood Association of South Africa have produced training packages for lifeskills training. Soul City and loveLife have both produced and mass distributed booklets on effective parenting.

loveLife.loveLife is funded by the Henry J Kaiser Foundation. It was launched in 1999. loveLife describes itself as a “deliberate departure from traditional approaches to HIV prevention,“ relying on a combination of commercial marketing and public health techniques to promote a new healthful lifestyle among 12-17 year old target group.” loveLife is a 5-year strategy designed to reduce the rate of HIV infection among 15-20 years olds by 50% in 5 years. loveLife combines high-powered media awareness and education with development of adolescent-friendly reproductive health services and other outreach and support programs (mobile?) for hard to reach youth in poor communities.

The aim has been to position the loveLife brand as part of youth culture. The key to loveLife’s approach is to get young South Africans to talk about sex, sexuality and gender relations or “talk about it”. The loveLife media campaign has concentrated on brand awareness and promotion through an initial teaser campaign designed to create intrigue to a clearer focus on sex and HIV. These teasers though were mystifying and thus really target free.

Key program elements of loveLife include-A sustained multimedia education and awareness campaign--including television, radio, outdoor media and print. Educating young people about HIV and promoting dialogue about sexual health issues. -The National Adolescent-Friendly Clinic Initiative, a major drive to establish adolescent health services in South Africa's 5,000 public clinics. -A national network of 16 multipurpose youth facilities, known as "Y-Centers”, providing recreation and skills training, as well as sexual health education and care in nonclinical settings.

Soul City.For over 10 years, this TV entertainment SUCCESSFULLY creates AUDIENCE awareness of AIDS and much more.Here are Soul City HIV/AIDS prevention messages--Series 2, 3 and 4:Anyone can get HIV/AIDSThere are ways of living positively with AIDSCondoms do prevent the spread of HIVSTDs should be treatedPeople with AIDS have rightsPeople with AIDS are not blameworthyPeople with AIDS like other people have hopes, fears and needs

The likelihood of positive HIV/AIDS behavior is about 4 times greater among quiz respondents with high exposure to Soul City TV than for respondents with no exposure to SC TV. This includes using a condom, asking one’s partner to use a condom, asking one’s partner to go for an HIV test, going for an HIV test oneself, and helping someone who is HIV positive. Of course, some people willing to help wear the red ribbon symbol ! ¿Are there mobile units in the countryside for dispensing condoms ?Soul City is a winner.

AIDS Thoughtalk.This open radio show is presented as a weekly debate forum on the USA-based World Talk Radio website. Launched in January 2004 by the Young Africans Welfare Association Zambia, the program covers HIV/AIDS-related questions, comments and issues that may have been absent from official global debate for action-stigma and discrimination. People worldwide may email the show host or call in live to engage in dialogue about the issues raised in the programs, to share past and present experiences, and to propose ways to take action. Experts host the show, and it is intended to be a forum bringing diverse voices together to develop fresh approaches to the problems.

Telephone helplines include the South African Department of Health’s AIDS Helpline; Soul City’s women’s helpline SAWH—Stop Abuse of Women Helpline; and loveLife’s Ithetha Junction. All of these tollfree helplines offer information and basic counselling support. Ithetha Junction is especially oriented to the needs of young people. SAWH like womens rights do relate to AIDS. Helplines provide a vital interactive element and are often the simplest course of action that can be taken for questions, obtaining access to resources, getting counseling support, and referral to local services.

The future ain’t what it used to be. How many decades after the epidemic is stopped will be needed so that life & development can proceed normally? Sex education for HIV/AIDS in the primary schools seems weak now. In contrast, the role of the mass media in promoting condoms and a healthful lifestyle is most fruitful and promising.This lecture provides grounds for optimism in South Africa which has a strong university system and strong antiHIV campaigns. What of the other African nations that are not so strong ? Civil wars, malaria, tuberculosis and starvation, orphans and on-n-on detract horrifically from war against the real enemy: AIDS.

Links. Where to find certain information is always a vital issue. The purpose of this lecture is to open doors to AIDS epidemiology. Links do this.Use the web network from THE COMMUNICATION INITIATIVE partnership: The Rockefeller Foundation, BBC World Service Trust, CFSC Consortium, The CHANGE Project, CIDA, Exchange, FAO, Ford Foundation, Johns Hopkins University Center for Communication Programs, OneWorld, The Panos Institute, PCI, Soul City, The Synergy Project, UNAIDS, UNICEF, USAID, WHO.

The following links with emphasis on African AIDS open the doors:http://allafrica.com/AllAfrica.com(news)http://www.afroaidsinfo.org/content/research/vaccines/vaccinetrial.htmAfro Aids Information http://www.acdi-cida.gc.ca/aids.htmCanadian Cidahttp://www.actionaid.org/stratshope/Strategies for Hope and Actionaid.http://www.comminit.com/index.htmlTHE COMMUNICATION INITIATIVE partnershiphttp://www.comminit.com/power_point/change_theories/sld031.htm

Prevention of AIDS in South Africa