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

Could Nemtsov Threaten Putin in Death as in Life?

Dynamic and debonair opposition leader had supported liberal economic reforms, criticized Russian president's aggression in Ukraine More

Oil Smuggling Highlights Challenges in Shutting Down IS Finances

Pentagon spokesman says Islamic State 'certainly continues to get revenue from the oil industry black market' but that airstrikes have made a dent More

India Focuses on Infrastructure, Investment to Propel Economy

Government expects economy to grow at 8 to 8.5 percent in next fiscal year 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.
US Supreme Court Hears Hijab Discrimination Casei
X
Katherine Gypson
February 25, 2015 11:30 PM
The U.S. Supreme Court has heard opening arguments in a workplace religious discrimination case that examines whether a clothing store can refuse to hire a young woman for wearing the headscarf she says is a symbol of her Muslim faith. Katherine Gypson reports from the Supreme Court.
Video

Video US Supreme Court Hears Hijab Discrimination Case

The U.S. Supreme Court has heard opening arguments in a workplace religious discrimination case that examines whether a clothing store can refuse to hire a young woman for wearing the headscarf she says is a symbol of her Muslim faith. Katherine Gypson reports from the Supreme Court.
Video

Video Falling Gas Prices Hurt Nascent Illinois Hydraulic Fracturing Industry

Falling oil prices are helping consumers purchase cheaper petroleum at the pump. But that’s made hydraulic fracturing or “fracking” less economically viable for the companies in the United States invested in the process. VOA’s Kane Farabaugh reports on one Midwestern town that was hoping to change its fortunes by cashing in on the next big U.S. oil boom.
Video

Video Fighting in Sudan's South Kordofan Fuels Mass Displacement

Heavy fighting in Sudan's South Kordofan state is causing hundreds of thousands to flee into uncertain conditions. Local aid organizations estimate as many as 400,000 civilians have been internally displaced since the conflict began more than three years ago, while another 250,000 have fled across the border to refugee camps in South Sudan. VOA's Adam Bailes reports.
Video

Video Lao Dam Project Runs Into Opposition

A Lao dam project on a section of the Mekong River is drawing opposition from local fishermen, international environmental groups and neighboring countries. VOA's Say Mony visited the region to investigate the concerns. Colin Lovett narrates.
Video

Video A Filmmaker Discovers Her Biracial Identity in "Little White Lie

Lacey Schwartz grew up in an upper middle-class Jewish family, in a town in upstate New York where almost everyone she knew was white. She assumed that she was, as well. Her recent documentary, Little White Lie, tells the story of how she uncovered the secret of her true racial background. VOA’s Carolyn Weaver has more on the film.
Video

Video Deep Under Antarctic Ice Sheet, Life!

With the end of summer in the Southern hemisphere, the Antarctic research season is over. Scientists from Northern Illinois University are back in their laboratory after a 3-month expedition on the Ross Ice Shelf, the world’s largest floating ice sheet. As VOA’s Rosanne Skirble reports, they hope to find clues to explain the dynamics of the rapidly melting ice and its impact on sea level rise.
Video

Video US-Cuba Normalization Talks Resume Friday

Negotiations aimed at normalizing diplomatic relations between the U.S. and Cuba resume Friday. On the table: lifting a half-century trade embargo and easing banking and travel restrictions. There's opposition in Congress, but some analysts say there may be sufficient political and economic incentives in both nations for a potential breakthrough this year. VOA's Mil Arcega reports.
Video

Video Pakistan's Deadline For SIM Registration Has Cellphone Users Scrambling

Pakistani cell phone users have until midnight Thursday to register their SIM cards, or their service will be cut off. While some privacy experts worry about government intrusion, many Pakistanis are just worried about keeping their phone lines open. VOA Deewa reporter Arshad Muhmand has more from Peshawar.
Video

Video Myanmar Warns Factory Workers to End Strikes

Outside Myanmar's main city Yangon, thousands of workers walked off their jobs earlier this month demanding a doubling of their wages, pay raises after a year and input from labor unions on industrial regulations. Since Friday, the standoff has grown more tense as police moved in to disrupt the sit-ins, resulting in clashes that injured people from both sides. VOA correspondent Steve Herman visited industrial zones which have become a focus of Myanmar's fledgling workers rights movement.
Video

Video Oscar Winners Do More Than Thank the Academy

The Academy Awards presentation is Hollywood’s night to reward the best movies from the previous year. It’s typically a lot of glitter, a lot of thank you’s, a lot of speeches. But many of this year’s speeches carried messages beyond the thank you's. VOA’s Carolyn Presutti takes a look.

All About America

Circumventing Censorship

An Internet Primer for Healthy Web Habits

As surveillance and censoring technologies advance, so, too, do new tools for your computer or mobile device that help protect your privacy and break through Internet censorship.
More