Your daily Selection of IRIN Africa PlusNews reports, 11/30/2005

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CONTENT:

1 - AFRICA: Testing helps avoid infection

2 - ANGOLA: Racing against time to prevent HIV/AIDS rate from rising

3 - CAMEROON: Local communities helping to change behaviour

4 - WEST AFRICA: West African glossary of slang terms for condoms

1 - AFRICA: Testing helps avoid infection

DAKAR, 28 November (PLUSNEWS) - Being tested for HIV, regardless of the result,

helps women start a dialogue to protect themselves and their partners from

infection, according to a new study.

French researchers conducted the " Ditrame Plus 3 " study in Cote d'Ivoire to

examine HIV risk management within couples and identify the factors that help or

hinder the adoption of preventative behaviour.

" We wanted to study behaviour patterns that were traditionally considered

low-risk because they occurred within a stable relationship, " bel Desgrees

du Lou, one of the study's co-authors, told PlusNews. " So we looked into things

like the role of monogamous vs. polygamous marriages, whether or not the

partners lived together, the degree of communication between them and the

preventative measures taken by the couple. "

The project started in 1995 and focused on pregnant women undergoing prenatal

care in two working-class neighbourhoods of Cote d'Ivoire's economic capital,

Abidjan. An HIV test was proposed to each of the women during the course of

their medical consultations.

Of those who met the study's requirement of having a regular partner, 322 tested

positive and 353 tested negative.

Over the course of the next 18 months, the researchers observed the women to see

if they spoke to their partners about HIV/AIDS, informed them of their test

results, encouraged them to get tested, and whether the couples took

preventative measures against HIV infection.

TESTING LEADS TO DIALOGUE

The results of the study varied according to the type of relationship, religion,

education level and relative ages of the partners, and whether or not they lived

together; but in all cases, discussion of HIV and sexually transmitted

infections (STIs) increased after testing.

While less than half the women reported having discussed STIs or HIV/AIDS with

their partners before their test, 96 percent of those who tested negative and 66

percent of those who tested positive subsequently initiated dialogue.

" It's clear that HIV testing in the context of prenatal care stimulates

communication on STIs and HIV/AIDS within couples, " said Desgrees du Lou. " It's

a good way to reach Mr and Mrs Q. Public. "

" Testing is a lot more productive than HIV awareness campaigns, " added Hermann

Brou, another of the study's co-authors.

Polygamy was one factor with a negative impact on establishing dialogue, and

more so if the couple did not live together.

" There was more discussion within polygamous couples staying under the same roof

compared to [monogamous couples] living separately, " said Desgrees de Lou.

ENCOURAGING PARTNERS

More than nine HIV-negative women out of 10 told their partners their results

and encouraged them to be tested - advice that was followed only 17 percent of

the time.

Only half the HIV-positive women informed their partners of their status, but

nearly 70 percent suggested they go for a test; only 22 percent of the men,

mostly from monogamous couples, did so.

Regardless of their test results, many women who were reluctant to talk directly

about HIV used more creative methods to raise the subject, especially regarding

prevention.

" Some women seized on domestic squabbles over extramarital affairs to ask their

partners to use a condom 'at least', " said Brou. " Others brought it up as a

joke, advising to 'cover up if you're going out'. "

If it was relatively easy for women to ask their partners to use a condom for

extramarital relations, it was much harder to suggest preventative measures

within their own relationship.

When couples resumed having sex after the birth, 30 percent of those in which

the woman was HIV-positive used condoms systematically. This figure rose to 50

percent if the partner had also been tested. Only 25 percent of couples with an

HIV-negative woman used condoms.

According to the study, communication and the partner's level of education were

the factors that affected condom use when the woman had tested positive. When

the results were negative, only the woman's level of education had an impact.

TARGETING THE COUPLE

According to Brou, all the women invoked contraception to persuade their

partners to use condoms. Among those unable or unwilling to demand condom use,

some resorted once again to indirect ways of protecting themselves or their

partners from HIV infection.

In the majority of cases, the women extended the period of abstinence after

giving birth to an average of 17 to 21 weeks, depending on their test results.

Women who did not live with their partners, or who were in a polygamous

marriage, had less trouble getting this extension accepted. On average they

lengthened the post-partum period of abstinence to 61 weeks and 37 weeks

respectively.

While the study found that testing motivated women to talk to their partners

about HIV and take steps to protect themselves better, the men were generally

unwilling to be tested or use protection.

In the future it will be necessary to target the men as well, especially in

polygamous unions where, " only the man knows the kind of relations he has with

each of his wives and it is, therefore, up to him to be aware of how to prevent

infection, " said Desgrees de Lou.

" An HIV-testing policy targeting couples, while taking into account the

particular needs of both partners in their specific relationship, could help to

overcome these obstacles, " Brou commented. " That way, the woman won't have to

bear all the responsibility for making the couple aware of the risks of HIV. "

[ENDS]

2 - ANGOLA: Racing against time to prevent HIV/AIDS rate from rising

LUANDA, 30 November (PLUSNEWS) - Condoms are embarrassing to buy, they spoil

sex, and if your partner insists on using one then they obviously don't trust

you.

It's a familiar refrain the world over, but in Angola, where hammering home the

safer sex message is vital if the country is to avert a widespread HIV/AIDS

pandemic, making condoms widely available and 'cool' to use is paramount.

Ironically, Angola's 27-year civil war insulated the country from the virus, but

the end of the conflict has seen refugees return from neighbouring countries

with higher prevalence rates and has encouraged people to move around within

Angola's borders, sparking fears that they could take HIV/AIDS with them.

The latest government figures put Angola's HIV/AIDS prevalence rate at less than

three percent, a remarkably low figure compared to the double-digit rates in

many other African countries, but there is scant research on the true extent of

the problem and many doctors, researchers and humanitarian workers privately

believe the real rate is much higher.

Scare stories abound, particularly in the provinces, where there are reports

that HIV/AIDS is regarded by some as a form of witchcraft or even " God's

punishment " . Condoms as a contraceptive are sometimes frowned upon in Angola's

catholic society, while a misplaced belief that the disease can be spread by

mosquito bites means some people see no point in protecting themselves.

But the news is not all bad, particularly among the urban youth, where education

efforts appear to be working.

" Using a condom is much safer for everyone - we are taught that in school, and

we take in all the advertisements on television and radio, " said 17-year-old

Beto, who wouldn't dream of having sex without a condom. " I don't believe there

is a single young person - in Luanda, at least - who is not aware of HIV/AIDS

and why they should use condoms to avoid it. "

That may be music to the ears of those seeking to curb the spread of the

disease, but the effort to break down concerns that condoms reduce pleasure and

can cause irritation needs to be maintained.

" Access to condoms has improved a lot in the last three years, but there are

still some cultural barriers to condom use, " said Dr Alberto Stella, the UNAIDS

Coordinator in Angola.

While Angola's urban youth seem to be aware of the theory, there is still a

sense that HIV/AIDS is something that happens to someone else.

" People know about HIV/AIDS, and well over half the youngsters we talked to were

personally worried about catching HIV/AIDS, yet when we asked them if they

thought they were at high risk, they said 'no', " said Gourvenec, Research

Director at Population Services International (PSI), an NGO that makes condoms

available at highly subsidised prices.

PSI distributed more than 10 million condoms in ten of Angola's 18 provinces

last year at just five kwanzas (less than 10 US cents) for a pack of four, so

cost is not a barrier to use.

" You can buy condoms very easily here in Luanda - at almost any store or

pharmacy - and they are cheap, so we have no excuse not to use them, " said

20-year-old Ernesto.

But PSI estimates that just 55 percent of Angola's youth used a condom last time

they had sex with a casual partner, a figure that drops dramatically if the

partner is classed as a boyfriend, girlfriend, husband or wife.

" It's embarrassing going to the shop and buying them, and I really only use them

so my girlfriend doesn't get pregnant - she would be upset if she thought I

thought I could catch something from her, " Ernesto said.

His condom use is erratic because he doesn't want to offend his girlfriend, whom

he trusts implicitly even though they have only been seeing each other for two

months.

Ernesto's eagerness to impress means he prefers to buy " decent " branded condoms,

but at 250 to 300 kwanzas for a box of four, or 50 to 60 times more expensive

than PSI's 'Legal' brand, he can't always afford them.

" Some people associate low price with low quality, although a condom is a

condom, " Gourvenec said. " But people want a bit more choice, so we're going to

put something out in the market to appeal to people who have a bit more

disposable income and who like the idea of buying something better. "

That's all well and good in Luanda and other urban centres, but many fear that

youngsters in the provinces, who haven't had as much access to the information

and education campaigns, could be sitting on an HIV/AIDS time bomb.

" We know all about it here, but I'm not sure the kids living in Huambo [province

in south-central Angola] or Cunene [province in the south] get the same

information, " said Beto.

" I think it is possible that Angola can escape the kind of levels we have seen

in Botswana and other countries, but only if the government keeps telling people

how dangerous it is, and makes sure that everyone across the country

understands, " he commented. " Then we have a chance to avoid this. "

[ENDS]

3 - CAMEROON: Local communities helping to change behaviour

DAKAR, 30 November (PLUSNEWS) - Realising that 20 years of awareness campaigns

had failed, Cameroon's HIV/AIDS officials have asked local communities to come

up with messages that will resonate among their members.

Professor Jacques-Philippe Tsala Tsala, a clinical psychologist and family

therapist in the capital, Yaoundé, is one of three experts asked in 2004 by the

National Committee for the Fight against AIDS (CNLS) to help establish this

innovative project in a country comprising at least 250 ethnic groups, each with

its own language.

" It was time to get away from messages that were conceived in the initial stages

of the fight, " Tsala told PlusNews. " Those messages were so general they didn't

address anyone, and the campaigns had no impact. "

Cameroon, like other African countries, initially tried to stop the spread of

the virus by alerting its population to the dangers of HIV/AIDS: rejection,

illness and death.

" Messages like 'AIDS can't be treated' or 'You're going to die' obviously missed

their mark or reinforced inadvertently suicidal behaviour, " Tsala pointed out.

The numbers speak for themselves. After holding steady at one percent between

1985 and 1990, the infection rate had jumped to over five percent by 1995,

especially among young people and women. Females made up three out of five cases

and a third of HIV-positive people were between the ages of 15 and 34.

Among sex-workers in big cities like Douala and Yaoundé, the infection rate

surged from six percent in 1987 to nearly 45 percent in 2000, the year the CNLS

launched its first campaign to change behaviour patterns.

Starting in 2000, health authorities changed tactics in the fight against HIV by

putting the emphasis on community participation. The goal was to keep the

infection rate below 10 percent, which was hovering around seven percent in

2003, according to the UN.

In 2001, provincial, local and community committees were created to raise

awareness and promote prevention.

" The problem wasn't telling people that AIDS existed, but letting them know what

to do about it, " Tsala commented.

A year later this strategy led to the creation of a " local answers " grassroots

approach by the CNLS that relied on youth and women's groups, school health

clubs, professional associations (drivers, sex-workers, etc.) and members of

religious groups or businesses to come up with community-based ways of fighting

the spread of AIDS.

The CNLS, which provides financial support for implementing these plans,

requires that people living with HIV/AIDS be included in the groups' activities

to ensure the quality of the information disseminated.

" It was necessary to include the targets of the messages in the process if we

wanted effective communication, " said Tsala. This strategy also required groups

to think more carefully about the words they used.

SEXUALITY AND TRADITIONS LIKE OIL AND WATER

Workshops have been organised in each of the country's 10 provinces to set out a

communication strategy for changing behaviour (CCC), to run from 2003 to 2007,

the impact of which will be studied at the end of the period.

For Tsala the increase in the number of people being tested in urban areas shows

that the message is getting out.

" Before now, testing - even when it was free and voluntary - was not popular

because it forced people to face up to a lot of responsibility, " he noted. " It's

still seen as opening up to others when, in fact, it means opening up to

oneself. "

This attitude can be explained partly by the intense prejudice faced daily by

people living with the virus, who are perceived as having questionable morals

and sexual behaviour.

Discussing sexuality openly is difficult in Cameroon because it is still very

much taboo, especially in rural areas. As a result, some community leaders have

made it nearly impossible to bring men, women and children together in one

place.

" We sometimes have to separate the groups even if that means a less effective

form of community expression, " Tsala told PlusNews. " The novelty of sexuality

discussions can lead to a number of unexpected reactions, like women covering

their faces, averting their eyes, and stifling laughter. "

At the same time there has been resistance to the egalitarian tone of some of

the awareness campaigns, which are at times perceived as a threat to traditional

authority.

Tsala said members of the community-level committees were often ridiculed ( " the

AIDSers " ) when they met with local people and traditional authorities.

" This prejudice, which can sometimes be pretty extreme, can't be explained away

by ignorance of the virus or how it is transmitted, " he wrote in the November

2004 issue of the journal of the Social Aspects of HIV/AIDS Research Alliance.

" It displays the complexity of the relationship between the self and an illness

that one can carry without even knowing it. "

AIDS activists in Cameroon are therefore careful not to ruffle feathers among

populations that are very attached to customs like the marriage of a widow to

her brother-in-law, traditional autopsy, female genital mutilation or

scarification.

" We avoid, for example, harping on male-female equality because doing so could

make prevention efforts more difficult, " Tsala commented, citing the example of

polygamy, a traditional form of marriage, within which " fidelity is still

possible " .

" The relationship between the sexes is one of the pillars of traditional social

fabric and it can't be changed without altering the entire society, " he said.

" And yet, the attitudes of certain husbands towards sexuality place their wives

in physical danger - that is an issue that needs to be addressed. "

Recent studies have also shown that 64 percent of girls between the ages of 15

and 19 are married or living with their partners.

Talking about condoms becomes a real challenge. " The different education

campaigns recommend that women have condoms in case their partners doesn't take

precautions, " Tsala explained. " But that advice can lead to misunderstandings: a

woman's decision to carry condoms can cause distrust between partners. "

Also, people in certain provinces view condoms as a kind of protective charm -

merely having one in one's pocket is thought to be enough to fend off sexually

transmitted diseases. According to Tsala, the latest awareness campaigns have

had to address this kind of fetishism.

" Social perception of this illness, of life and death, belief systems, local

cultures, sexual behaviour, the status of women, religions, relations between

individuals and the state - all of these are 'partners' with which we have to

negotiate if we want to be successful, " Tsala remarked.

He wondered how best to incorporate difficult concepts like the cultural

significance of life and death in traditional societies into prevention

messages.

" Do the people we're targeting really want to live? They can have

self-destructive impulses that we don't understand, " he explained. " The value

one places on life is subjective and people could easily say to me: 'Did I say

that life was so good to me that I want to protect it?' "

[ENDS]

4 - WEST AFRICA: West African glossary of slang terms for condoms

DAKAR, 30 November (PLUSNEWS) - COTE D'IVOIRE

(terms used in the region of Noe on the border between Cote d'Ivoire and Ghana)

- sock: Alpha Blondy, a popular Ivorian musician, stresses the importance of

using a 'sock'

- 'godasse': French slang for 'shoe'; from an expression common among truckers:

" Condoms protect and so do shoes. "

- chocolate or candy: " because you shouldn't suck on a candy that's still

wrapped " ; " it's possible to have fun with or without chocolate "

- pills

- panther biscuits

- shin-guard: among the military

- underpants

TOGO

- 'godasse'

- Tontonvi: from the name of the actor in the first televised AIDS prevention

message

- 'afogode': Mina word for 'sock'

- travel pass

- 'robavi': Mina word for 'little plastic'

- pinch-and-roll: from the latest campaign by international NGO Population

Services International on the proper use of condoms

- 'preso': short for 'preservatif', the French word for 'condom'

- godevi': Mina expression meaning 'little undergarment'

- 'anevi': Ewe word for 'little packet'

- 'dowonou': Mina word for 'work tool'; young people refer to sex as 'working'

NIGER

- 'hullar mazakuta': Hausa word for 'sex cap'

SENEGAL

- 'kawass': Wolof word for 'sock'

- shin-guard

- Protec: brand of condoms

- 'mank': Wolof word for 'little ball'

This PlusNews feature is part of a series called 'Beyond ABC: The Challenge of

Prevention'. To view the full set of 15 articles, visit the PlusNews web special

at:

http://www.irinnews.org/webspecials/prevention/default.asp

[ENDS]

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