AIDS in South Africa: The Invisible Cure

This piece explores what the author describes as a "striking and deeply mysterious" denial of the reality of AIDS in South Africa. This country has one of the highest infection rates in the world and an equally high level of awareness about how to avoid being infected. Why, the author asks, have so many HIV prevention programmes - like those addressing high-risk youth - been so radically unsuccessful?

Epstein explains that many of the efforts to change the sexual behaviour of young people in South Africa have tapped into what youth seem to respond to most readily - material culture, images of beauty and glamour, and fun/play. For example, one programme, loveLife (click here for a programme description) has posted more than a thousand billboards in South Africa. On one of them, the hands of four women of different races caress the sculpted back and buttocks of a young black man. The caption reads, "Everyone he's slept with, is sleeping with you." The idea is to create a "brand" of sorts - characterised by cool, hip, attractive peers so irresistible that young people will want to associate with them (by being glamorous yet at the same time models of restraint).

LoveLife has established a small network of recreation centres for young people, known as Y-Centers, throughout the country. These centres are meant to be positive and cheerful places, in line with the director's philosophy that traditional HIV prevention campaigns are depressing and scare kids away. At the centres, young people can learn to play basketball and volleyball, as well as break-dancing, radio broadcasting, and word processing. All Y-Center activities are led by "loveLife GroundBreakers" - youths in their early twenties, who "are stylish and cheerful and enthusiastic about their product, in this case, loveLife and its program of encouraging sexual restraint". If messages promoting abstinence and monogamy fail, each Y-Center is affiliated with a family planning clinic that offers contraceptive pills and condoms, as well as treatment for sexually transmitted infections (STIs). The centres offer no treatment for AIDS symptoms, however, and only some of them offer HIV testing. Any young person can become a Y-Center member, but in order to fully participate in its activities, he or she must participate in seminars that emphasise the biological aspects of HIV and its prevention but not the experience of the disease and its effects on people's lives. Members also receive training to raise their self-esteem. According to Epstein, these young people were certainly talking openly about sex during the seminars. Nevertheless, she noted, "I felt something was missing". AIDS is not discussed directly, she says.

Reflecting on her visit to loveLife seminars, Epstein writes: "The techniques of marketing attempt to impose scientific principles on human choices. But it seems a mad experiment to see whether teenagers living through very difficult times can be persuaded to choose a new sexual lifestyle as they might choose a new brand of shampoo, or that children can be trained to associate safe sex with pizza and self-esteem."

Epstein looks critically at these efforts in the context of very different, smaller, community-based HIV/AIDS prevention programmes like those launched in Uganda, which have focussed on telling the stories of people actually afflicted with the disease. For example, St. Charles Lwanga is a Catholic organisation that carries out an AIDS programme in Uganda called Inkanyezi. With a budget less than one tenth of what loveLife spends on billboards alone, this programme provides counseling to young people about AIDS and also brings food and other necessities to 400 orphans and people living with AIDS in the Vaal Triangle. The programme is staffed almost entirely by volunteers, whose only compensation is that they are allowed to eat some of the food - usually rice and vegetables - that they prepare for the patients. The emphasis is on face-to-face interaction with people actually suffering with AIDS.

These programmes have, on the whole, been very successful. In Uganda and the adjacent Kagera region of Tanzania, HIV rates fell from around 18% in the early 1990s to around 6% today. She attributes this success, in part, to an unusually active response to AIDS on the part of ordinary people. She believes that their activities (mainly feeding and nursing patients and their families) gave patients some dignity and brought AIDS into the open. Some of the NGOs involved in these projects - many of which were launched by people who had watched friends and family die of AIDS - also conducted village meetings, rallies, and drama and musical performances that encouraged people to avoid HIV by remaining faithful to a single sexual partner, or by using condoms. What makes many of these events particularly powerful, Epstein claims, was that the speakers and performers often dealt openly with the effect of AIDS in their own lives.

To explore this hypothesis, Epstein met with a group of young people to ask how their lives had been changed by the virus. They said they had witnessed extreme prejudice and discrimination against people with AIDS, and they did not know where to turn when they learned that a relative or friend was HIV-positive. Epstein argues that the loveLife Y-Center does not focus its efforts on helping young people deal with this kind of confusion, stigma, and shame. She points out that the centres do offer individual counseling for a small number of young people with HIV, instead telling those who are hungry, homeless, or destitute, or who are suffering from the symptoms of AIDS to consult other NGOs like Inkanyezi. In general, she says, although sex is openly discussed at the Y-Center, the experience of AIDS is not. One girl said, "I learned basketball at the Y-Center, and at meetings we talked about resisting peer pressure, [like when] your friends advise you to break your virginity, to prove you are girl enough. But I was afraid the people there would find out my sister had HIV. We talked about it as though it was someone else's problem." Epstein's conclusion is that programmes designed to prevent AIDS "should pay greater attention to the real circumstances in people's lives that make it hard for them to avoid infection."

Click here for the full article online.

Please note: at the time we posted this summary, this article was freely available. Unfortunately, there is now a US $4.00 charge for the full article.