Your daily Selection of IRIN Africa PlusNews reports, 11/29/2005

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[These reports do not necessarily reflect the views of the United Nations]

CONTENT:

1 - AFRICA: Beyond ABC - The challenge of prevention

2 - SOUTH AFRICA: Life, love and prevention after HIV/AIDS

1 - AFRICA: Beyond ABC - The challenge of prevention

JOHANNESBURG, 28 November (PLUSNEWS) - <b>OVERVIEW</b>

In theory, preventing HIV/AIDS seems simple enough: give people information on

how the disease is spread, and the desire for self-preservation will, naturally,

make them adopt safer sexual behaviour.

The reality has proved much more complex. Almost 30 years after it was first

diagnosed, ignorance about HIV/AIDS still persists. Even more challenging is the

realisation that some of those who are aware of the message are ignoring it, or

are powerless to negotiate safer sex.

According to the UNAIDS Epidemic Update for 2005, [<a

href= " http://www.unaids.org " target= " _blank " >www.unaids.org</a>] " there is new

evidence that prevention programmes initiated some time ago are currently

helping to bring down HIV prevalence in Kenya and Zimbabwe " but, overall,

prevention efforts have a poor track record, particularly in sub-Saharan Africa,

which is home to two-thirds of all people living with HIV.

Much of the continent has initiated treatment programmes, but experts warn that

unless the incidence of HIV/AIDS is sharply reduced, treatment will not be able

to keep pace with the number of people needing therapy.

HIV prevention opens a Pandora's box of issues, such as sex and sexuality, and

forces people to re-evaluate societal and individual factors that may be

contributing to the epidemic.

The cost of failure is clear. The Global HIV Prevention Working Group [<a

href= " http://www.gatesfoundation.org/nr/downloads/globalhealth/aids/PWGFundingRe\

port.pdf " target= " _blank " >www.gatesfoundation.org</a> <img

src= " ./images/pdf-logo.gif " width= " 10 " height= " 10 " align= " absmiddle " alt= " pdf

Format " >] estimates that if existing prevention interventions were brought to

scale, nearly two-thirds of the 45 million new infections projected to occur

between 2002 and 2010 could be averted.

<b>BARRIERS TO HIV PREVENTION</b>

Some AIDS researchers maintain that the inability to induce long-term

behavioural change lies in the nature of the messages: top-down, fear-inducing

lectures on safe sex by national AIDS bodies do not acknowledge that sex is

about desire, love, the irrational and the illicit; cultural contexts, gender

roles, and the influence of peers confound a " one size fits all " approach to

awareness and motivating people to take change their ways.

'Facing the Future Together', a study by the UN Secretary-General's Task Force

on Women, Girls and HIV/AIDS in Southern Africa, [<a

href= " http://www.unicef.org/publications/files/SGs_report__final.pdf "

target= " _blank " >www.unicef.org</a> <img src= " ./images/pdf-logo.gif " width= " 10 "

height= " 10 " align= " absmiddle " alt= " pdf Format " >] called for a departure from

the orthodox prevention approach, pointing out that the ABC strategy - abstain,

be faithful and use a condom - did not fit the needs of women and girls.

" The messages have been missing the mark, " the report observed. One reason was

the " not only widespread, but widely accepted and endorsed " prevalence of rape

and sexual violence against women and girls.

In a context where men grow up believing masculinity means having plenty of

sexual partners, being faithful to your husband does not prevent infection:

using a condom requires a willing partner, and in a region where one in five

women is physically abused, fear can undermine insistence on protection.

If prevention activities were to succeed, the task force said, they needed to be

coupled with efforts, such as legal reform and the promotion of women's rights,

to address and reduce violence against them.

Men have to play a role - societal norms about masculinity also make them

vulnerable to HIV infection, as they are encouraged to engage in risk-taking

behaviour.

Amy Kaler, a sociologist who conducted research into men and behaviour change in

Malawi, found that " skin-to-skin ejaculation is the marker of a real man - one

who uses condoms is being cheated out of his right to a high-grade sexual

experience, or may even be the subject of gossip or ridicule " .

Prevention messages emphasising safe behaviour and not taking chances did not

resonate with masculine sub-cultures, she pointed out. " Playing safe is not

really what you want to do as a young man " , which needed to be taken on board

when designing interventions.

Culture was another barrier, and UNAIDS admitted in its policy position paper on

HIV prevention that " while culture can function as a vehicle for promoting HIV

infection, it must be recognised that it can also constitute a barrier against

HIV prevention " .

<b>MOVING BEYOND ABC</b>

The success of Uganda's fight against AIDS has been largely attributed to its

president, Yoweri Museveni, who took the bold decision to speak out publicly

about what was considered a shameful disease and tell people how to combat it.

Prevention strategies, including the promotion of condoms, were central to the

achievement.

But in recent years the Ugandan and US governments have shown increasing

interest in promoting abstinence and fidelity in marriage, with condoms given

only to those who cannot manage either.

Activists argue that while abstinence until marriage and fidelity inside

marriage are admirable, human weakness, transactional sex, existing gender roles

and the difficulty of changing behaviour dictate that condom use must be at

least as well promoted, and condoms must be easily available.

In an article in the British Medical Journal [<a

href= " http://bmj.bmjjournals.com/cgi/content/full/bmj;328/7444/891 "

target= " _blank " >http://bmj.bmjjournals.com/</a>], Halperin, a prevention

expert with the US Agency for International Development (USAID), and his

colleagues pointed out that behaviour change programmes to prevent HIV

transmission have mainly promoted condom use or abstinence, while the 'be

faithful', or partner reduction, component of ABC had been neglected.

" We have a public health responsibility to help people understand the strengths

and limitations of each component, and not promote one to the detriment of

another. For example, although abstinence may be a viable option for many young

people, for others it may be an unrealistic expectation. Likewise, even though

prospective studies have shown that condoms reduce risk by about 80 to 90

percent when always used, in real life they are often used incorrectly or

inconsistently, " the article commented.

Changing human behaviour is not an overnight process. In the meantime,

technologies old and new, from diaphragms to vaccines, are being investigated,

in the hope that science will succeed where attempts to alter human behaviour

have not done as well as anticipated.

A recent study in South Africa found that circumcised men were at least 60

percent less likely to become infected than those who were uncircumcised. Two

similar trials are underway in Uganda and Kenya, with results expected later

this year. If they support the Johannesburg study, male circumcision is likely

to be added to the cocktail of prevention mechanisms.

Professor Alan Whiteside, director of the Health Economics and HIV/AIDS Research

Division at the University of KwaZulu-Natal, observed that strategies had

neglected to address the distinct prevention needs of people living with

HIV/AIDS, and warned that this not only posed a threat to people living with

AIDS, but also to future generations.

" We have to consider the dangers of re-infection among HIV-positive people, as

well as the possible emergence of new strains of HIV. This would also raise huge

concerns about the ability of current treatments to fight a new and possibly

stronger version of the HI virus, " he noted.

" The issue of prevention, however, should not rest solely on the shoulders of

government, " Whiteside said, " as it has a great deal to do with individual

choice. "

[ENDS]

2 - SOUTH AFRICA: Life, love and prevention after HIV/AIDS

JOHANNESBURG, 25 November (PLUSNEWS) - South Africans are finding that being

HIV-positive is not the end of living and loving, but despite the provision of

pre- and post-HIV test counselling, no effort is being made to address how

HIV-positive people should negotiate the dating game.

UNTOLD TRUTHS OF LIFE AND LOVE AFTER HIV/AIDS

(name changed), who is HIV-positive, said this oversight reinforced a

belief that infected individuals would lose their libido in the myriad of

emotional and societal challenges they faced.

" There was a long period after being diagnosed that I felt unattractive.

Physically, I became a shell of my former self and sexual intimacy was the last

thing on my mind, so prevention was never an issue at that time. But not long

after starting on antiretrovirals [ARVs], my appetite, weight and sexual

interest was again revived, " he told PlusNews.

Although serving as a green light for to push on with his life, the

accompanying sexual re-awakening presented weightier considerations.

In his search for gratification, became engaged in a tug of war between

disclosure and almost inevitable rejection, or the choice of using a condom and

keeping his status secret.

" Having to tell your family or close friends is easier because they usually

accept you, no matter what. But your relatives can't satisfy your sexual needs,

and the full implications of having to disclose is only really grasped when you

try to feed your sexual hunger. "

The sting of rejection quickly cancelled out any guilt he felt in keeping his

positive status from casual sex partners ... provided condoms were always used.

" But even after condom-use you are left wondering whether or not you infected

the other person - conflicting views that condoms might not be as safe as we

would like to believe only adds to any feelings of guilt. "

He found it disturbing that HIV-positive people might still be having sex

without protection, despite evidence of rising AIDS rates and warnings about

reinfection.

" I was not adequately prepared for life or sex after AIDS, and it would have

been much easier if there were some way of knowing whether the other person was

also HIV-positive, " he said.

DIFFERENT STROKES FOR DIFFERENT FOLKS

Ben Sassman, the founder of Positive Connection, a non-profit website that

offers people like a chance to share experiences and maybe even find a

partner again, told PlusNews that he knew only too well the emotional pain

suffered by friends living with HIV/AIDS.

" HIV-positive people are living longer productive lives as a result of the

ever-increasing availability of ARVs. With this renewed lease on life also comes

a need for love and fulfilment, sexual or otherwise. These needs make it

important for HIV-positive people to not only pay close attention to their own

health and safety, but also to that of their partners. This site tries to serve

as a guide for those people who might have been sidelined by prevention

campaigns, " he said.

According to Sassman, the site was unique in that it promoted prevention and

safety by encouraging subscribers to be honest about their HIV status, but at

least 36 dating sites currently operating in South Africa cited the promotion of

stigma as a hurdle for failing to do so.

Arguing that stigma would always be there, Sassman noted that HIV-positive

people should at least have the choice of going through life with rejection by

uninfected people, or with the love and support of someone also living with

AIDS.

" People are led to my site by fear of rejection in the outside dating world,

where they found that after disclosing their dates would make excuses not to see

them again. It is not like letting a date know you have a serious non-infectious

disease. For many people, becoming romantically involved with an HIV-positive

person raises concerns about physical safety, " he commented.

Concerned that people could easily become reckless as their confidence in the

life-prolonging abilities of ARVs increased, Sassman urged anti-AIDS campaigns

to revisit prevention when tackling the pandemic.

READY OR NOT ... HERE WE COME!

The startling results of an annual global survey released in November 2005 by

condom producer Durex has also raised questions about the efficacy of prevention

campaigns.

According to the 'Durex Global Sex Survey', conducted online among 317,000

people in 41 countries, a large portion of already hard-hit South Africa was

still engaging in unprotected sex without any knowledge of the partner's sexual

history.

The findings showed that the proportion of unsafe sex - an estimated 64 percent

- was much higher than the global average of 47 percent.

" When compared to last year's results, the statistic is higher, which means that

South Africans continue to take risks and put their lives in danger, " said Durex

in a statement accompanying its survey results.

In its 'HIV and Syphilis Antenatal Sero-prevalence Survey' for 2005, the

department of health said between 6.29 million and 6.57 million people were

living with HIV/AIDS by 2004 - far higher than the recent 4.5 million estimated

by the government statistics agency, Stats SA.

DOCTOR ALWAYS KNOWS BEST

Professor Alan Whiteside, director of the Health Economics and HIV/AIDS Research

Division at the University of KwaZulu-Natal, said that although anti-AIDS

treatment was a critical part of tackling the pandemic, the importance of

prevention should never be forgotten.

" By just treating the disease we are not addressing the root cause of it, which

is people contracting the virus. The whole question of prevention is in danger

of being lost, not just by government, but by the overall public. If we take our

eyes off the ball for even a short while, we will have lost, " he told PlusNews.

Whiteside noted that prevention for HIV-positive people had not received the

attention it deserved, and warned that this not only posed a threat to people

living with AIDS, but also to future generations.

" We have to consider the dangers of reifection among HIV-positive people, as

well as the possible emergence of new strains of HIV. This would also raise huge

concerns about the ability of current treatments to fight a new and possibly

stronger version of the HI virus. "

Highlighting that there was no sign of the pandemic being brought under control

in South Africa and neighbouring countries, he recommended that officials focus

on rolling out prevention together with antiretrovirals.

" The issue of prevention, however, should not rest solely on the shoulders of

government, " Whiteside said, " as it has a great deal to do with individual

choice. "

[ENDS]

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