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

Photogallery Pistorius Sentenced, Taken to Prison

Pistorius, convicted of culpable homicide in shooting death of girlfriend Reeva Steenkamp, will likely serve about 10 months of five-year sentence, before completing it under house arrest More

UN to Aid Central Africa in Polio Vaccinations

Synchronized vaccinations will be conducted after Cameroon reports a fifth case of the wild polio virus in its territory More

WHO: Ebola Vaccine May Be in Use by Jan.

WHO assistant director Dr. Marie Paule Kieny says clinical trials of Ebola vaccines are underway or planned in Europe, US and Africa 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.
After Decades of Pressure, Luxembourg Drops Bank Secrecy Rulesi
X
October 21, 2014 12:20 AM
European Union finance ministers have reached a breakthrough agreement that will make it more difficult for tax cheats to hide their money. The new legislation, which had been blocked for years by countries with a reputation as tax havens, was approved last week after Luxembourg and Austria agreed to lift their vetoes. But as Mil Arcega reports, it doesn’t mean tax cheats have run out of places to keep their money hidden.
Video

Video After Decades of Pressure, Luxembourg Drops Bank Secrecy Rules

European Union finance ministers have reached a breakthrough agreement that will make it more difficult for tax cheats to hide their money. The new legislation, which had been blocked for years by countries with a reputation as tax havens, was approved last week after Luxembourg and Austria agreed to lift their vetoes. But as Mil Arcega reports, it doesn’t mean tax cheats have run out of places to keep their money hidden.
Video

Video Kobani Refugees Welcome, Turkey Criticizes, US Airdrop

Residents of Kobani in northern Syria have welcomed the airdrop of weapons, ammunition and medicine to Kurdish militia who are resisting the seizure of their city by Islamic State militants. The Turkish government, however, has criticized the operation. VOA’s Scott Bobb reports from southeastern Turkey, across the border from Kobani.
Video

Video China Political Meeting Seeks to Improve Rule of Law

China’s communist leaders will host a top level political meeting this week, called the Fourth Plenum, and for the first time in the party’s history, rule of law will be a key item on the agenda. Analysts and Chinese media reports say the meetings could see the approval of long-awaited measures aimed at giving courts more independence and include steps to enhance an already aggressive and high-reaching anti-corruption drive. VOA’s Bill Ide has more from Beijing.
Video

Video US ‘Death Cafes’ Put Focus on the Finale

In contemporary America, death usually is a topic to be avoided. But the growing “death café” movement encourages people to discuss their fears and desires about their final moments. VOA’s Jerome Socolovsky reports.
Video

Video Ebola Orphanage Opens in Sierra Leone

Sierra Leone's first Ebola orphanage has opened in the Kailahun district. Hundreds of children orphaned since the beginning of the Ebola outbreak face stigma and rejection with nobody to care for them. Adam Bailes reports for VOA about a new interim care center that's aimed at helping the growing number of children affected by Ebola.
Video

Video Young Nairobi Tech Innovator on 'Track' in Security Business

A 24-year-old technology innovator in Nairobi has invented a tracking device that monitors and secures cars. He has also come up with what he claims is the most robust audio-visual surveillance system yet. As Lenny Ruvaga reports from the Kenyan capital, his innovations are offering alternative security solutions.
Video

Video Latinas Converting to Islam for Identity, Structure

Latinos are one of the fastest growing groups in the Muslim religion. According to the Pew Research Center, about 6 percent of American Muslims are Latino. And a little more than half of new converts are female. VOA’s Carolyn Presutti travelled to Miami, Florida -- where two out of every three residents is Hispanic -- to learn more.
Video

Video Exclusive: American Joins Kurds' Anti-IS Fight

The United States and other Western nations have expressed alarm about their citizens joining Islamic State forces in Syria and Iraq. In a rare counterpoint to the phenomenon, an American has taken up arms with the militants' Syrian Kurdish opponents. Elizabeth Arrott has more in this exclusive profile by VOA Kurdish reporter Zana Omer in Ras al Ayn, Syria.
Video

Video South Korea Confronts Violence Within Military Ranks

Every able-bodied South Korean male between 18 and 35 must serve for 21 to 36 months in the country’s armed forces, depending upon the specific branch. For many, service is a rite of passage to manhood. But there are growing concerns that bullying and violence come along with the tradition. Reporter Jason Strother has more from Seoul.
Video

Video North Carolina Emerges as Key Election Battleground

U.S. congressional midterm elections will be held on November 4th and most political analysts give Republicans an excellent chance to win a majority in the U.S. Senate, which Democrats now control. So what are the issues driving voters in this congressional election year? VOA National Correspondent Jim Malone traveled to North Carolina, one of the most politically competitive states in the country, to find out.
Video

Video Comanche People Maintain Pride in Their Heritage

The Comanche (Indian nation) once were called the “Lords of the Plains,” with an empire that included half the land area of current day Texas, large parts of Oklahoma, New Mexico, Kansas and Colorado.The fierceness and battle prowess of these warriors on horseback delayed the settlement of most of West Texas for four decades. VOA’s Greg Flakus reports from Lawton, Oklahoma, that while their warrior days are over, the 15,000 members of the Comanche Nation remain a proud people.
Video

Video Turkey Campus Attacks Raise Islamic Radicalization Fears

Concerns are growing in Turkey of Islamic radicalization at some universities, after clashes between supporters of the jihadist group Islamic State (IS) or ISIS, and those opposed to the extremists. Pro-jihadist literature is on sale openly on the streets of Istanbul. Critics accuse the government of turning a blind eye to radicalism at home, while Kurds accuse the president of supporting IS - a charge strongly denied. Henry Ridgwell reports from London.

All About America

AppleAndroid