HEALTH: Poor Nations Need Not Look Far for HIV/AIDS Successes

By Feizal Samath Reprint | | Print |

Feizal Samath

KATHMANDU, May 25 2001 (IPS) - “If governments have been working for many years on preventing AIDS, why are the number of cases increasing instead of decreasing?” asked 14-year-old Kelzang Dorjee from Bhutan.

In response, a delegate at a South Asian conference on children here this week said that the public education messages on HIV/AIDS by governments may have not worked.

“If that is the case, why not change the messages?” Dorjee asked. No one among the government officials and business leaders in the meeting, which ended Wednesday, could provide a quick answer to his question.

Dorjee was one among many youngsters who attended a unique meeting here this week among South Asian children, businessmen and government officials to discuss the need to invest more in children.

The youngsters asked corporate leaders and government officials about spending and priorities on issues affecting children — including HIV/AIDS.

Children made their presence felt at the two-day meeting, distributing condoms to surprised delegates as well as asking some pointed questions which flummoxed many adults.

At the meeting, ministers of finance and planning and officials were urged to allocate more budget resources on HIV/AIDS education and awareness while corporate leaders were told to spend more money and time on this issue.

The meeting also drove home the point that in reviewing the thrust of their HIV/AIDS programmes, success in HIV prevention is not necessarily confined to industrialised countries.

Developing countries struggling to contain HIV/AIDS in their backyard do not have to look to far for lessons on how to deal with the pandemic and can learn from countries like Senegal, Thailand and Uganda.

A new U.N. report on the success of HIV prevention programmes, presented at the meeting, tackles issues like cultural barriers and social traditions against public education of HIV/AIDS.

“For instance, who would have imagined that an imam or Muslim priest would promote HIV/AIDS programmes in Uganda in not only creating an awareness on the issue, but also encouraging the use of condoms?” Werasit Sittitrai, associate director for Asia and the Pacific of the Joint United Nations Programme on AIDS (UNAIDS), asked during a panel discussion here.

The UNAIDS report, prepared in April and titled ‘HIV Prevention Needs and Successes: A Tale of Three Countries’, noted that in developing countries, prevention activities aimed at changing behaviour and associated social norms can and do work, not only on a large scale but also at national level.

Examples of change include an increase in condom use, reduction in visits to sex workers, postponement of first sex and reduction in the sharing of injecting equipment among drug users.

UNAIDS said Uganda was hard hit throughout the 1980s, and has had almost two million cumulative deaths to date. Senegal has not been seriously affected by the epidemic. Thailand’s crisis became more prominent only at the end of the 1980s, but spread rapidly once it took hold.

“These are three different situations, but behavioural change and some containment of the epidemic were achieved in all three,” the report said.

More than 36 million people in the world are living with HIV/AIDS while 30 million children have been orphaned due to it. In South Asia alone there are more than five million people living with HIV/AIDS, U.N. figures show.

“That is just the tip of the iceberg. These figures do not represent the real problem. There are many more infected with the disease that are unreported and not added to these numbers,” says Kul Gautam, deputy executive director for the United Nations Children’s Fund (UNICEF).

Mechai Viravaidya, the UNAIDS ambassador known as ‘Mr Condom’ because of his ground-breaking efforts in Thailand to promote condom use among sex workers and others, said Thailand succeeded in HIV/AIDS promotion by tackling the issue at different levels.

“We have taxi drivers promoting condoms to passengers. We have involved farmers, gas stations, restaurants and many others in promoting condom use and creating public awareness,” he said.

Mechai said every occupation suffers from HIV/AIDS. “Whether you are poor or rich enough to have 15 Mercedes Benz cars doesn’t matter. Money doesn’t prevent risk behaviour,” he added.

While urging governments to put more resources to HIV/AIDS prevention, Mechai said that after a time budget allocations for HIV/AIDS work are diverted to health care. “Health care is important but public education on HIV/AIDS is also important,” he said.

Gautam, responding to a query by the Bhutanese Health Minister Lyonpo Sangay Ngedup that if national budgets focus on AIDS there might be less resources for other communicable diseases, said that UNICEF is not advocating a major re-allocation of resources.

“What we would like to see is more money in a basket of goods like health services and AIDS education and social development. We need more public education and awareness by governments on HIV/AIDS. That does not only mean putting in more money but also non-financial resources,” he added.

The UNAIDS report on success stories noted that the common features that emerged in Uganda, Thailand and Senegal included strong political commitment at the highest level in dealing with the epidemic, multisectoral approaches to prevention and care, and reaching out to the public and high risk groups.

In Uganda, two national surveys in 1989 and 1995 (comparing the two years) on delayed age of sexual preferences and other issues showed some interesting findings.

For the youngest, the 15-year olds, the proportion of boys or girls reporting that they had never had sex rose from around 20 percent to around 50 percent. Overall the age of sexual initiation had shifted upward.

Another finding showed that the percentage of sexually active men and women who reported using condoms increased significantly. “If the numbers are merged, the proportion of men who said that they had ever used a condom rose from 15 percent to 55 percent. Among women, the total rose from six percent to 39 percent,” the UNAIDS report said.

In Uganda, the report said the incidence of HIV infection has fallen among pregnant women in urban areas and a falling prevalence among other groups too has been seen.

In Senegal, the government involved religious leaders in a Muslim-dominated society to make HIV/AIDS a regular topic at Friday sermons in mosques, in addition to religious leaders talking about it on television and radio.

The Thai HIV prevention story is based on a national effort to promote safe behaviour and to change norms, increase of condom use during both casual and commercial sex.

“There are instances where women even gave their husbands (whom they believe were cheating on them) condoms for protection in a practical approach to the problem,” noted Mechai.

In 1985 about 400,000 people — mostly men — were diagnosed with sexually transmitted diseases in Thailand but by 1996 this number fell sharply to 50,000.