Prevention needs attention!
We need to be engaging in a constructive discussion and debate on the HIV/AIDS prevention campaigns in South Africa (see more in our Prevention fact sheet). The recent debates in the media about the efficacy of loveLife’s campaign is a start, at least, although sadly, they have been reduced to a pinch of mud-slinging here and a dash of bruised egos there.
This is not the first time, I, or many other people I know, have thought about this issue or talked about it. It is nothing new, but something that has been circulating for a while. But two recent events brought it home for me.
Firstly, the annual Ruth First Memorial Lecture was held at Wits University last week. I was delighted and privileged to witness Henk Rossouw’s presentation of his fellowship work, entitled The Broken Tin: Treating AIDS without treatment. It is an exemplary piece of journalism on HIV/AIDS and I hope once it is published in full it is recognised as such (any takers for an 11 000-word gem?) An extract from his piece was published in the Mail&Guardian and is well worth the read (though it’s accessible to subscribers only). Zackie Achmat acted as a respondent and touched on many issues which are in their own right material for more blogs than I have the energy to pen: the media’s failure to take up the STATS SA survey earlier this year which reported an estimated 3-million deaths due to AIDS, the continuing crisis of governance and leadership around HIV/AIDS in South Africa and the continued scientific and political denial of HIV and AIDS which fuels stigma. But it was his comment about the “crisis of prevention” that really got me thinking. He articulated what many of us feel: the prevention campaigns in South Africa are failing us. Miserably.
Between the irrelevant and quite frankly, antiquated “ABC” model and the confusing and obscure loveLife campaign, we are lacking campaigns that really speak to us in ways that resonate with our lived, everyday experiences.
Secondly, there has been renewed debate in the past couple of weeks on the loveLife campaign in the media. In the August 19 Mail&Guardian, Rena Singer questioned the efficacy of loveLife’s ” unorthodox” and “slick” campaign in the face of some of the challenges we face in this country, such as a rising number of new infections and a serious lack of material and human resources in the public health setting.
Thomas J Coates, in a letter published in the following week’s M&G, responded to Singer’s concerns by stating that the loveLife campaign is a “grand experiment worth undertaking”, meaning that we should let the loveLife “experiment” run its course and then evaluate its outcomes and determine its impact in the same way we would a clinical trial. The only problem is, this is one costly “experiment” to be undertaking - R780-million thus far - and, with so much at stake, the “wait and see” approach doesn’t really seem appropriate.
David Harrison, CEO of loveLife, has also entered the fray, accusing Singer of:
“…[promoting] cynicism about the efficacy of South Africa’s largest HIV-prevention effort targeting youth without offering insight into a more effective, alternative approach.”
Yes, we do need creative alternatives to the existing models of HIV/AIDS prevention in this country. I can’t claim the authority to know what these are, but I can certainly give it a bash.
Isn’t it time to start asking people about their sexual practices - what they really get up to when it comes to sex? And with this information, to produce prevention campaigns that really address what people are actually doing and how they can make what they are doing a little safer? Perhaps a snippet of anecdotal evidence will illustrate this point. A group of researchers in Kwazulu-Natal found that a lot of young girls were engaging in unprotected anal sex. After some more investigation it was found that the girls had misread the prevention messages they had received on HIV/AIDS. Because the campaigns focus so heavily on penetrative sex and vaginal sex, as if they were one of the same, these girls thought that anal penetrative sex was safe! This also feeds into the wide practice of anal sex as a contraceptive device. Does this not point to the need for accurate, clear messages that reflect our practices and assist us to understand how to keep ourselves safer while engaging in these practices?
What I’m talking about here is the task of taking into account the gendered, social, cultural, economic contexts in which we live - differently, diversely and unevenly - and construct campaigns that really deal with the realities of our lives in a way that helps us to make sense of our practices and what we can do to make them a little safer. This applies to those of us who have penetrative vaginal sex, or penetrative anal sex or oral sex, or sex with older men, or sex outside of marriage with other men or other women. And the infinite possibilities on the continuum from the one to the other.
There is a desperate need for smaller media campaigns that really reach the heart of communities, in which there are people literally dying for more information about HIV/AIDS.
Communities that are flattened by the stigma, denial and silence that persists because of a lack of clear and accurate information on the virus. In places where every young girl seems to have a baby on her hip, and the massive purple and green billboard in the middle of town doesn’t really seem to resonate with her life.
When I see these young girls I guess I don’t stop to consult them about what they think about the loveLife billboards and I don’t ask them whether it provokes within them aspirations for a better, healthier lifestyle. They seem to be too busy getting on with the job of living a reality that pretty much sucks.
And, as an aside, according to Harrison “only” a third of 12 to 17-year-olds are sexually active, his implication being that because the majority of his audience are HIV-negative, it’s OK to dismiss them. This kind of attitude prompts me to ask the question: Why are we not directing resources into messages that target those of us who are sexually active and/or HIV-positive and/or engage in practices that aren’t necessarily “normative”? Why is it that all these campaigns seem to presume a majority, homogenous, HIV-negative audience?
Harrison is right, we do need to be looking hard for alternatives, for ways to really engage with people to facilitate them making better choices around the kind of sex they are having. I don’t claim to have the answers, but give me R780-million, and I’ll make sure I do a damn good job finding them.- Natalie Ridgard