South Africa Fights AIDS

SOWETO, South Africa – Collin Williams’ long, French-tipped nails animatedly sliced through the air as he described the unique community in which he works, as if his piercing words and direct stare weren’t enough to capture its essence.

The welcoming sounds of children chanting the alphabet and the consistent pop of billiard balls colliding from the nearby game room contrasted sharply with the “Enter at Your Own Risk” sign taped to the front door near the main entrance. Williams’ modest clothing made the program manager at the Tehillah Community Center seemright at home in the mildly lit paved halls.

He spoke with evident pride as he explained the center’s unique, hands-on outreach initiatives that make it a cornerstone in the Soweto community, specifically in terms of dealing with HIV prevention, treatment and support.

While South Africa still has one of the largest HIV/AIDS infection rates in the world, programs like the Tehillah center have helped reverse the trend. A specific, notable decrease has been shown among youth aged 2 – 24 in a 2008 HIV Prevalence Survey released by the National Department of Health. The survey reported decreases from 5.6 percent in 2002 to 2.5 percent in 2008 in children aged 2 – 14, and 10.3 percent in 2005 to 8.6 percent in 2008 in children aged 15-24.

Non-governmental organizations and government agencies have joined forces to develop effective outreach campaigns to spread the message of abstinence, monogamy, regular testing and condom use.

A national survey in 2008 was designed to comparatively evaluate the various factors causing South Africa’s high infection rates, specifically addressing each of South Africa’s provinces. “A Turning Tide Among Teenagers?” reported males and females aged 15–24 had the highest reported rates of condomuse at last sex among all age groups.

“In the schools, guys and girls use the condoms for shoe polish, yet they still count them in their stats. They need to come to the communities and find out how many people are really using condoms for sex,” Williams said.

He emphasized that his one-on-one experiences of working within the community proved that statistics don’t reflect the reality of teenage sexual practices.

Williams said his honesty about his status as being HIV-positive and homosexual combined with his leadership role in the community has established a bond of trust and confidence between him and community members. He frustratingly recalled an argument with the department of health about lack of follow-up about condom use after distribution.

“The education programs our government has done over the past few years haven’t been effective, because they gloss over the topic,” Williams said. “That was the biggest embarrassment to us in our country. If the leadership doesn’t take it seriously and doesn’t want to take it head-on then the masses won’t take it seriously.”

Williams said he feels that the government has a detached approach to prevention.

 The community center practices an interactive approach to prevention, including having five on-duty nurses available at the center for counseling and separate sex-education discussion groups for young girls and boys.

Williams said these practices significantly contributed to the drop in teenage pregnancy rates and young infection rates in the area since the center’s opening in 2008.

Obstacles still remain to decreasing the infection rate, however, as South Africans battle the complex factors influencing the differing rates across the provinces.

Dr. Liz Floyd, the director of the Multi-Sectoral AIDS Unit in Gauteng Province, said the complex issue of high infection rates among young adults who are out of school and unemployed is one of the most difficult challenges the government is trying to approach.

Floyd, head of the government branch designed to specifically address AIDS in Gauteng Province, added that the lack of opportunity for students to advance their education or gain employment once they leave secondary school creates a multi-faceted barrier beyond simple AIDS awareness and prevention methods. The complexity of the issue segues into economic and educational concerns as well, which is why the department relies on cooperation and support from within communities.

She placed emphasis on an entirely different, if not marginalized, portion of the population facing similar difficulties: low-income, middle-aged women.

“We have a higher HIV infection rate among poor women because of a tendency to have sex for income; not necessarily for cash, but for survival,” Floyd said.

Floyd reported that middle-aged women have one of the highest infection rates of all population groups because of too many instances of forced sex without a condom. Her experience has shown that preaching the importance of safe sex and prevention is not a high priority for people, particularly women, in circumstances of extreme poverty.

The futility of the government’s programs has left many critics calling for a change in policy and leadership. A member of the Provincial Legislature for Gauteng Province and a Democratic Alliance spokesman, Neil Campbell, spoke out against what he characterized as an outdated and ineffective platform.

“It’s pathetic,” Campbell said. “HIV/AIDS is treated as a special disease in this country. Because there was an element of stigmatization with the disease, you weren’t allowed to even mention the word HIV. Instead we have these loveLife campaigns where we put out a whole lot of glossy papers, but half of the people can’t read because we’ve got education standards that are so low. I believe that our government has failed us here, and President Zuma with his shower solution to first exposure prophylaxis takes the cake.”

Campbell was referring to a statement Jacob Zuma made in 2006 – before he became president –during a trial in which he was accused of raping an HIV-positive woman. Zuma’s defense to not using a condom was that he left the bedroom and showered after they had consensual sex, minimizing his risk of infection. 

The controversial comment was one of many that supported claims of government apathy toward the epidemic. However, the government is now campaigning to spread awareness and prevention to reduce the country’s high infection rate.

Sarah Laurence, a consultant at Health and Development Africa and a member of the African non-governmental organization’s research team, said a survey was conducted by Health and Development Africa to evaluate various communication campaigns around HIV. The survey’s results reflect a success that conflicts with Campbell’s stance that the campaigns are futile. The survey even formed a direct link between media campaign exposure and the likelihood of using a condom during sex.

“If you had only seen one mass media campaign around HIV prevention you were less likely to use a condom as compared to somebody who had seen five and even less like than somebody who had seen all 11,” Laurence said of the survey’s results.

The country has numerous media campaigns, including Soul City, addressing issues like the importance of monogamy and condom use among teenagers, and Brothers for Life, which promotes male empowerment and accountability for sexual practices. While each of South Africa’s campaigns appeals to a different audience and promotes varying messages, one consistent theme is emphasized in all HIV campaigns: self-responsibility to prevent infection.

 Reported by “A Turning Tide Among Teenagers,” the Soul City campaign (mainly focused toward adults) and the Soul Buddyz campaign (focused on children) uses multiple media outlets, both broadcast and print.

These outlets, combined with practical activities like Soul Buddyz clubs, allowed for over 75 percent of youth aged 15-24 to be exposed to Soul City’s campaign in 2008.

“People always ask do these campaigns work, and what we’re seeing is that they do work,” Laurence said. “They have worked on certain key indicators; on other indicators they haven’t been shown to be very effective but I think that’s because the messaging is quite new.”

The highest exposure rate, however, came from the government –sponsored campaign, loveLife, which reached79 percent of youth aged 15–24 in 2008, as reported by “A Turning Tide Among Teenagers.” 

The Multi-Sectoral AIDS Unit’s approach goes beyond pamphlets, television and radio commercials: the unit provides workshops to promote self-esteem among women and basic skill training to increase survival skills. This campaign, Floyd says, has promoted a significant increase in condom use among middle-aged women living below the poverty line.

South Africa was able to use its role as 2010 FIFA World Cup hosts to reach extend the reach of the government’s awareness and prevention message, and the tournament provided a platform for the unit’s outreach campaigns.

A Brazilian samba band, decked out in white pants and teal T-shirts, performed to a gathering crowd as people slowly milled onto the New Market square in Newtown before the recent World Cup final. A long bus with larger than life figures in various capoeira positions sprawled across the sides and a large red bow tightly tied around the door caught the curious stares of passers-by.

The festive atmosphere surrounding the launch of the Wake Cup campaign provided a distinct contrast to the seriousness of the AIDS epidemic in South Africa.  The coordinating partners of the Wake Cup campaign, the Multi-Sectoral AIDS Unit, a local non-governmental organization, Bridges of Hope, the Brazilian government and the Brazilian Ministry of Health, used “the party of football” as a platform for South Africa’s battle with HIV.

The coordinator of the launch and a member of the campaign, Valentina Brena Torres, said the purpose of the day was to create an atmosphere of fun and excitement to capture and maintain the audience’s attention while still conveying the importance of condom use.

“That’s the importance of getting in with the people and inviting people to get on the bus,” Brena, a Uruguayan, said. “Once they get on the bus we have different cartoons about how to use a condom and different kinds of cartoons or drawings by different designers; we try to make a funny story to explain each of the drawings. We try to talk with the people and we invite them to participate in our plays. Then, after this, we hand out the condoms and the pamphlets.”

The bus and surrounding market square remained a bed of activity well into the day. Volunteers mingled in the crowd, distributing condoms from large cardboard boxes and pamphlets demonstrating proper condom use.

Oliver Kulilishika, a social worker from Lusaka, Zambia, visiting Newtown, said the festive atmosphere immediately sparked his curiosity.

“The campaign has an impact. Being a social worker, I think it’s a very good approach, and it’s something I feel I could adapt to my country when I get back to Zambia. It’s an eye-opener for me, using visual aids as an approach towards the eradication of HIV,” Kulilishika said.

The launch was the first of many days of music, skits, condoms and soccer as the bus travelled to various fan parks throughout Gauteng for the duration of the World Cup.

Laurence stressed that while research continues to show overall positive results, she would like to see more campaigns, like the Wake Cup, that take a proactive, direct approach to the problem with local campaigns.

“I’d really like to see our findings being used to enforce a local level response,” Laurence said. “From a research point of view, it would nice to see our findings actually translated into action.”

Brena agreed, issuing a call to action to those unaware of the pandemic and its effects in particular on sub-Saharan Africa.

“We can’t wait for the politicians,” Brena said. “As much as we want to join up with them, everyone has to start with something; bit by bit, as each person comes, we can put a brake on the spread of AIDS in the world.”