News / Africa

Grassroots Efforts Help Reduce HIV in Africa

Swaziland billboard encourages faithfulness in sexual relationships. (photo: Daniel Halperin)
Swaziland billboard encourages faithfulness in sexual relationships. (photo: Daniel Halperin)
William Eagle
A prominent American epidemiologist Dr. Daniel Halperin is encouraging international health experts to support behavior change as a primary tool in helping to prevent the spread of HIV. 
 
He expresses his views in a new book Tinderbox: How the West Sparked the AIDS Epidemic and How The World Can Finally Overcome It It’s co-authored by Craig Timberg, the former Johannesburg editor for The Washington Post newspaper.

Cutting edge

The authors say there are relatively inexpensive and even traditional ways of reducing new infections.  One is male circumcision -- a practice that they say has already kept infection rates low in places where it’s common. 
 
Washington Post journalist Craig Timberg explained why the disease has made less of an impact in some parts of Africa than others. He made his comments on a recent broadcast of Book-TV on the C –Span television network:

A Swaziland billboard encourages fidelity and responsible fatherhood. (Daniel Halperin)A Swaziland billboard encourages fidelity and responsible fatherhood. (Daniel Halperin)
x
A Swaziland billboard encourages fidelity and responsible fatherhood. (Daniel Halperin)
A Swaziland billboard encourages fidelity and responsible fatherhood. (Daniel Halperin)
​"As transport routes improved, HIV [made] its way into East Africa – Rwanda, Uganda, and parts of Kenya close to Lake Victoria where men are not circumcised," said Timberg.

"That’s because they are from a different ethnic tradition.  Rather than coming over from Nigeria and West Africa, they came from the Sudan and down the Nile Valley, so you have millions of men who were not circumcised.  When the virus makes its way into that population,  suddenly  you get this explosive kind of spread –instead of an infection rate of one or two percent of adults, you see  10, 15,  and in some places 20 percent of adults."

Among those hardest hit, he says, were the Luo ethnic group in Kenya and the Zulu in South Africa – both which do not practice male circumcision.

Low tech, high rewards
 
Timberg said the international community responded slowly to studies showing that circumcision was effective, showing a preference instead for high-tech solutions to treat those infected with HIV.  But that’s changing, he told an audience at the Foreign Policy Research Institute in Philadelphia:
 
"Male circumcision science only gets stronger with each passing year as they follow up these guys who were circumcised in 2002-03 for these landmark studies," said Timberg. "They’ve done three randomized controlled trials – the gold standard for medical research.  In all three of these cases, they shut the trials down early because the men who were not getting circumcised were getting HIV so much faster than the men who were circumcised that it was regarded as no longer ethnical to keep those trials going.  

"In the years since that happened they’ve done long term follow ups," he continued, "Whereas they were saying at first circumcision was 60 percent effective -- as the years pass, the protection goes up:  70%, 75%..".

Fear and compassion

Besides circumcision, Timberg says several countries have mounted effective campaigns to change behavior.
 
He said new infection rates dropped in several countries, including Uganda and Zimbabwe, long before the availability of life-prolonging drugs. 
 
In Uganda,  a campaign by the government of President Yoweri Museveni nearly 20 years ago appealed to public fear and compassion.  It included billboards with skulls and crossbones,  war drums warning early morning radio listeners about the seriousness of HIV/AIDS, and a commercial featuring the voice of a young girl urging her father to be faithful.

Van used in Uganda's AIDS prevention campaign of the 1980's (Photo: by Daniel Halperin)Van used in Uganda's AIDS prevention campaign of the 1980's (Photo: by Daniel Halperin)
x
Van used in Uganda's AIDS prevention campaign of the 1980's (Photo: by Daniel Halperin)
Van used in Uganda's AIDS prevention campaign of the 1980's (Photo: by Daniel Halperin)
The campaign also urged the adoption of what was called “Zero Grazing”.  It encouraged men and women to restrict their number of partners.
 
"The idea is that when a (tethered) goat is staked at a homestead and he grazes (only) in that spot, it looks like a zero because he can only go so far,"  explained Timberg.

"This was a message that was clever in part because even if you are in polygamous marriage, zero grazing works for you, too.  As long as sexual activity was happening within the “homestead,” that was fine. So what they saw in Uganda was this [notable] decline over the course of five years the average number of partners that people had."

The weight of HIV
 
He says Zimbabwe and Zaire [now the Democratic Republic of the Congo] also had their own effective grass roots reactions to the threat of HIV/AIDS.
 
In Zaire, popular pop singer Franco stirred public debate about the disease with his radio hit Attention na SIDA (Beware of AIDS). Franco denied having HIV,  though the heavy-set musician lost weight and died within years of his hit.

A Zimbabean woman walks past a billboard promoting male cirumcision to combat AIDS in the capital (Philimon Bulawayo/Reuters)A Zimbabean woman walks past a billboard promoting male cirumcision to combat AIDS in the capital (Philimon Bulawayo/Reuters)
x
A Zimbabean woman walks past a billboard promoting male cirumcision to combat AIDS in the capital (Philimon Bulawayo/Reuters)
A Zimbabean woman walks past a billboard promoting male cirumcision to combat AIDS in the capital (Philimon Bulawayo/Reuters)
Subsequent studies found the tune had resonated with the public. One survey of people in 10 cities across the nation showed half of those interviewed said they were familiar with the song, and had reduced their number of sex partners. Meanwhile, a study of over 3,000 health care workers showed those having extramarital relations dropped from 54% to 40% during the peak years of airplay for the Franco hit.  
 
Timberg said about 12 years ago in Zimbabwe, an economic crisis exacerbated by a controversial land reform program meant less money for men to spend in bars and on girlfriends. 

Starting the conversation
 
More importantly,  civil society leaders and -- as in Zaire -- pop stars started the country talking about the only way to avoid infection and death: changing sexual behavior.
 
"The Zimbabweans, shunned and ignored," said Timberg, "have this [surprising]  drop in HIV cases.  In Zimbabwe as in some other places, they had a singer Oliver Mtukudzi – who had lost a brother and four band members in a span of about sixteen months.  He had a song called What Shall We Do  (and another called Stay with One Woman).  It was less preachy than some of the other songs by some African singers over the years, but it does seem to part of this conversation Zimbabweans were having with one another about what to do about this terrible disaster."

Swaziland billboard warns young women against dating married men. (photo: Daniel Halperin)Swaziland billboard warns young women against dating married men. (photo: Daniel Halperin)
x
Swaziland billboard warns young women against dating married men. (photo: Daniel Halperin)
Swaziland billboard warns young women against dating married men. (photo: Daniel Halperin)
Timberg said that international health surveys showed that between 1999 and 2005, the number of married men reporting sex outside of marriage dropped by 30% in Zimbabwe. The adult HIV rated dropped from a peak of 29% by half. 

The co-author of “Tinderbox,” epidemiologist and medical anthropologist Daniel Halperin, credited the change largely to fear, and to the broad participation of civic and religious leaders.

Secret lover
 
In Swaziland, a popular campaign against HIV used billboards and cellphone messages to warn against multiple partners:  One advertisement began with a cell phone message saying “I’m dying to have you.”  An accompanying message warned “Why destroy your family ? Your secret lover can kill you.”  Other billboards encouraged men to be faithful to one partner and to practice responsible fatherhood. 
 
A USAID-funded analysis of the program found that nearly 90 percent of Swazis queried had heard of the campaign, and a vast majority of them considered changing their behaviors as a result. 
 
The authors of the Tinderbox, Danial Halperin and Craig Timberg, say there’s a subtle bias toward anti-retrovirals and other biomedical approaches. 

Prevention as treatment
 
Today, many health experts favor “treatment as prevention.”  Under the strategy, ARV’s are given as a prophylaxis to an uninfected partner in a couple where one already has HIV.  They are also given early to those infected by HIV but who do not yet exhibit symptoms. Testing shows early use of ARV’s help prevent the spread of the virus in both those who have been exposed to HIV, and those who have not.

But Halperin and Timberg say the effort is expensive and will be difficult for many local health care systems to handle. Studies also show that many people fail to take toxic drugs until symptoms develop. 

Uganda poster during Zero Grazing era aims to promote changes in sexual behavior. (photo: Daniel Halperin)Uganda poster during Zero Grazing era aims to promote changes in sexual behavior. (photo: Daniel Halperin)
x
Uganda poster during Zero Grazing era aims to promote changes in sexual behavior. (photo: Daniel Halperin)
Uganda poster during Zero Grazing era aims to promote changes in sexual behavior. (photo: Daniel Halperin)
The authors say promoting behavior change as well as male circumcision is much less expensive that some of the other approaches, and have roots in local culture.
 
“If men and women living amid severe epidemics dial back, even modestly, their number of sexual partners,” say the authors, the vast network created by multiple and concurrent relationships collapses.  The virus then finds it harder to find new victims, and everyone in the community, they say, is safer.

Listen to report on HIV and behavior change in Africa
Listen to report on HIV and behavior change in Africai
|| 0:00:00
...    
🔇
X

You May Like

For Lebanon-based Refugees, Desperation Fuels Perilous Passage

In a war that has caused an estimated three million people to flee Syria, efforts to make perilous sea journey in search of asylum expected to increase More

South African Brewer Tackles Climate Change

Mega-brewer SAB Miller sent delegates to climate summit in Peru, says it is one of many private companies taking their own steps to fight climate change More

Indonesia Reports Increase in Citizens Joining Islamic State

Officials say more than 350 of its citizens are now in Syria or Iraq to fight with Islamic State - 50 more than last month More

This forum has been closed.
Comments
     
There are no comments in this forum. Be first and add one

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Will Pakistan School Shooting Galvanize Pakistan Against Extremism?i
X
Ayesha Tanzeem
December 17, 2014 11:54 AM
The attack on a military school in Pakistan’s northwest city of Peshawar left 141 dead, including 132 children. Strong statements of condemnation poured in from across the world. The country announced three days of mourning, and the leadership, both political and military, promised retribution. VOA's Ayesha Tanzeem looks at how likely the Pakistani government is to clamp down on all extremist groups.
Video

Video Will Pakistan School Shooting Galvanize Pakistan Against Extremism?

The attack on a military school in Pakistan’s northwest city of Peshawar left 141 dead, including 132 children. Strong statements of condemnation poured in from across the world. The country announced three days of mourning, and the leadership, both political and military, promised retribution. VOA's Ayesha Tanzeem looks at how likely the Pakistani government is to clamp down on all extremist groups.
Video

Video ‘Anti-Islamization’ Marches Increase Tensions In Germany

Anti-immigrant rallies in Germany have been building in recent weeks, peaking Monday night in the city of Dresden where tens of thousands of people turned out to demonstrate against what they call the ‘Islamization’ of the West. Germany has offered asylum to more Syrian refugees than any other country, and this appears to have set off the protests. Henry Ridgwell reports from London.
Video

Video Aceh Rebuilt Decade After Tsunami, But Scars Remain

On December 26, 2004 there was an earthquake in the Indian Ocean so powerful it caused the Earth’s axis to wobble a few centimeters. Onshore on the island of Sumatra, the resulting tsunami was devastating. A decade later, VOA Correspondent Steve Herman reports from Banda Aceh, Indonesia, where although there is little remaining evidence of the physical devastation, the psychological scars among survivors remain.
Video

Video Refugees Living in Kenya Long for Peace in the Home Countries

Kenya is host to numerous refugees seeking safe haven from conflict. Immigrants from Somalia face challenges in their new lives in Kenya. Ahead of International Migrants Day (December 18) Lenny Ruvaga has more for VOA News from the Kenyan capital.
Video

Video Turkey's Authoritarianism Dismays Western Allies

The Turkish government has been defiant in the face of criticism at home and abroad for its raids targeting opposition media. The European Union on Monday expressed dismay after President Recep Tayyip Erdogan lashed out at Brussels for criticizing his government's action. Turkey's bid to be considered for EU membership has been on hold while critics accuse the NATO ally of increasingly authoritarian rule. Zlatica Hoke reports.
Video

Video US-China Year in Review: Hong Kong to Climate Change

The United States is pushing for a code of conduct to resolve territorial disputes in the South China Sea as it works to improve commercial ties with Beijing. VOA State Department correspondent Scott Stearns reports on a year of U.S. policy toward China from Hong Kong to climate change.
Video

Video Japanese Leader’s Election Win Raises Potential for Conflict with Neighbors

Japan’s Prime Minister Shinzo Abe and his allies easily won a two-thirds majority in parliament Sunday, even though the country has slipped into recession under his conservative policies. VOA’s Brian Padden reports from Seoul, that the prime minister’s victory will empower him to continue economic reforms but also pursue a nationalist agenda that will likely increase tensions with Japan’s neighbors.
Video

Video Nuba Mountain Families Hide in Caves to Escape Aerial Bombings

Despite ongoing peace talks between Sudan's government and the rebel Sudan People’s Liberation Movement-North, or SPLM-N, daily aerial attacks continue in South Kordofan province’s Nuba Mountains. Adam Bailes was there and reports for VOA that government forces are targeting civilian areas, rather than military positions, with their daily bombardments.

All About America

AppleAndroid