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Pure way to fight HIV/AIDS
Prof Suzanne Leclerc-Madlala. Sunday Tribune, 6 January 2003. Republished courtesy of Independent Newspapers (Pty) Ltd
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The bitter-sweet irony of our failure to halt the spread of HIV/AIDS is that the failure itself could be the catalyst to slow the killer epidemic.
With more than half of all deaths now attributed to HIV/AIDS-related illnesses, there is some heartening evidence that people are beginning to see the wisdom of changing their sexual behaviour. Better late than never, but it's sad that it has taken a decade of prevention-focused work on HIV/AIDS for the penny to drop.
In 2003 this focus will undoubtedly be overtaken by treatment and care as priority issues. From now on, with HIV/AIDS in our homes, killing our loved ones, people will demand treatment. People will demand government action. Perhaps this is a good time to reflect on how millions of well-intentioned Rands have done little to propagate social responsibility and reverse the infection rate.
More than any other African country, South Africa has had the financial, technical and human resources to create a sophisticated, nationwide media blitz against HIV/AIDS. We have developed a slick youth campaign encouraging kids to take control of their lives and their developing sexualities. This full-house, multi-media campaign has found its way into nearly every South African home, and has even made its presence known in remote areas through billboards and events sponsorships. For sheer market saturation and brand-name familiarity, our HIV/AIDS awareness campaign has surely been successful.
Yet one wonders whether the message of this campaign is the most appropriate for the majority of young South Africans in the frontline of the HIV/AIDS tsunami. Spiked of hair and pierced of navel, these beautiful, hip, straight-talking teens could just as soon be kids from Los Angeles of Glasgow as from Alexandra or Tugela Ferry.
Perhaps that's the point: teenagers everywhere face similar challenges when it comes to looks, fashion, love and life in the HIV/AIDS era. Indeed, youth concerns may be similar, but a case needs to be made for engaging more directly with our local context.
The youth who grace (and read) the HIV/AIDS-awareness supplements that tumble regularly from our newspapers are middle-class, sophisticated and seem likely to spend their weekends enjoying multiracial camaraderie in suburban rave-clubs. They are the chosen ones. Wittingly or unwittingly, the thrust of our national HIV/AIDS prevention effort speaks primarily to this narrow band of privileged youth. Are they the only ones we hope to be spared of death through HIV/AIDS? We can only assume that this type of social prejudice has not been intentional.
It's far more likely that many more of SA's youth spend their weekends listening to music with friends or just hanging about in doorways that dot poverty-lined roads. Their aspirations probably have less to do with fashion and clubbing and more to do with finding enough hope and basic resources to sustain their future.
One wonders whether our national approach to HIV/AIDS prevention has more to do with proving to the world (and to ourselves) that we are indeed a sophisticated, advanced nation quick to pick up on all the latest global trends. This is probably why we find it difficult to take a leaf from the anti-HIV/AIDS strategies of comparatively primitive places like Uganda or Zambia. It means eating a bit of humble pie and shaking off some of our "better-than-the-rest of Africa" attitude. When it comes to reducing HIV/AIDS infection rates, we have nothing at all to teach the rest of Africa. Rather, some much poorer countries have much to teach us.
Uganda's success in lowering HIV/AIDS prevalence from a high of 21% in 1991 to a mere 6% in 2001 is largely unique for sub-Saharan Africa, although Zambia looks set to follow suit. In spite of this success, one troublesome fact emerges: condoms had relatively little to do with it. Like most South African men, Ugandan men never really took to condoms. Instead, the campaign worked because it brought about real behaviour change and also created social support for the nuts and bolts of the campaign - abstinence and faithfulness.
In contrast, Botswana and Zimbabwe have gone straight for the preventive option. Both countries continue to plug the use of condoms (as in South Africa) and both continue to lead the world with very high, and rising, HIV/AIDS infection rates.
As dreadfully outdated as it might sound, Uganda's experiences strongly suggest that the promotion of abstinence before marriage and marital faithfulness could be the keys to halting the spread of HIV/AIDS on this continent. According to one World Health Organisation official, Uganda's model for HIV/AIDS prevention has the potential to reduce HIV/AIDS rates in hard-hit countries by 80%: the same level of efficacy that one could expect from a vaccine. Imagine that.
But promoting such concepts in South Africa would not be easy. For a start, we are dogged by a serious reluctance to come to terms with even the most basic facts of the epidemic. Beyond that, abstinence and faithfulness are such unpopular notions. Who would be willing to produce glossy media materials to convey such killjoy messages? Truth is, our hip-hyped HIV/AIDS prevention campaign and its condom-promoting, "have-fun-but-play-it-safe" message has failed.
It is also perhaps time to take a good, hard look at our assumptions about youth and how we conceptualise HIV prevention. There are many fears to be faced in this epidemic, and some of them have to do with our fear of taking an unpopular stand. In our current context, however, abstinence and faithfulness are simply the safest-sex messages we have.
Why have these messages not been given a fraction of the media attention given to the promotion of condoms? Given the epidemic we face, these twin strategies represent far more than moral choices; they are sensible health choices and real survival tactics.
Ultimately, it's sad that one feels compelled to justify taking a moral stand against a pandemic poised to destroy every gain ever made by this country. Perhaps now that events are overtaking us, these new forces might prompt us into decisive and potentially unpopular stands that could make a real difference.
Professor Suzanne Leclerc-Madlala is Head of Anthropology at the University of KwaZulu-Natal in Durban. |
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