Download “no point in being tested.” Then it is important to expand information

Prevention of AIDS
in South Africa
Paul R. Earl
Facultad de Ciencias Biológicas
Universidad Autónoma de Nuevo León
San 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 website
Behavioral 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 than
with 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’s
promotion 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 resources
that 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 was
developed 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
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/AIDS
There are ways of living positively with AIDS
Condoms do prevent the spread of HIV
STDs should be treated
People with AIDS have rights
People with AIDS are not blameworthy
People 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 actionstigma 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/vacc
ines/vaccinetrial.htm Afro Aids Information
http://www.acdi-cida.gc.ca/aids.htm Canadian Cida
http://www.actionaid.org/stratshope/ Strategies
for Hope and Actionaid.
http://www.comminit.com/index.html
THE COMMUNICATION INITIATIVE partnership
http://www.comminit.com/power_point/change_
theories/sld031.htm