Health-Southern Africa: Teenagers Notice More Aids, More Condoms
Inter Press Service (Johannesburg)
November 9, 2004
Posted to the web November 9, 2004
Christina Scott
Cape Town
The progress of the nasty little virus known as HIV can be monitored on its devastating journeys through bodies and communities. People's factual knowledge about the disease can be tracked. But getting more information in people's head does not automatically change their behaviour in bed.
This is very irritating for special interest groups who have already decided on people's sexual lifestyle. Anti-condom lobbies insist that people will be more tempted by pre-marital or extra-marital sex. Groups promoting safe sex are equally convinced that if people are given a condom, they will use it. But human beings refuse to fit into categories.
One study conducted among both urban and rural youth in the mountainous southern African kingdom of Lesotho uncovered a considerable number of teenagers who had noticed more AIDS and more condoms - and deduced that the latex must be the source of the virus!
Some scientists say it is only recently that they have recognised the importance of tracking sexual behaviour, citing intriguing declines in HIV infection, including Uganda and other countries in Africa. Are infection rates down because people are practicing safe sex, or because the infected have died? It is hard to tell, sometimes because the experts are so immersed in their technical language that it is hard to know what they are saying.
South Africa is often considered the epicentre of the epidemic. Even that causes the researchers conducting surveys to throw up their hands in dismay. "I never know what people mean with such broad statements," grumbles Rob Dorrington, director of the Centre for Actuarial Research at the University of Cape Town in South Africa. "We have the greatest number of infected individuals, which is a silly number since it depends on the size of the country. Botswana and Swaziland have much higher rates than South Africa, they just happen to be much smaller."
According to the 2004 Report on the Global AIDS Epidemic produced by UNAIDS, the average prevalence among pregnant women in Swaziland was 39 percent in 2002 - up from 34 percent in 2000 and only 4 percent in 1992.
In Botswana, antenatal clinic prevalence has been sustained at 36 percent in 2001, 35 percent in 2002, and 37 percent in 2003.
In South Africa, prevalence among pregnant women was 25 percent in 2001 and 26.5 percent in 2002, according to the UNAIDS report.
Many sexually active South Africans do not want to talk about AIDS. And those who do talk may not have very accurate memories. After all, if an intimidating retired hospital matron - the type used as field researchers in one national study - wanted to know if you had had unprotected sex, would you dare answer yes? "Self-reported changes in behaviour are never perfect," says AIDS researcher Dr Olive Shisana of South Africa's Human Sciences Research Council (HSRC). "They are subject to bias, to under-reporting."
"Personally, I don't even tell the truth when someone stops me in a shopping mall to ask questions about hair conditioner. I pick the answer that will get me away as soon as possible. If people will lie about political candidates and shampoos, why wouldn't they lie about sex?" she says.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) Reference Group on Estimates, Modelling and Projections knows that this is a tricky issue. They will meet in Harare, Zimbabwe, this month - Shisana will be among those attending - to provide advice on methodology. Their main advice: tread carefully. The problem is that for every solution, there are flaws. Test pregnant women, say some. Well, some women do not know they are pregnant for a good long time. Some pregnant women avoid clinics. Some use traditional healers. Not all women are pregnant!
In landlocked Lesotho the virus has reached into every rural village courtesy of a colonial-era economy which relies on the men leaving their farming families to mine gold in neighbouring South Africa. The Lesotho Development Bank has identified a long-term threat to the stability of the country: many children drop out of primary and high school because there is no money due to the illness or because they are needed to nurse the parents. The students do not return after burying them.
It is difficult to triangulate the infection, the changes in behaviour and awareness programmes, and anyone who claims it is easy is peddling something - either an ideology or a product. If your parent dies from AIDS, do you practice safe sex or resign yourself to a similar fate? Hunt for scapegoats or put your faith in roadside peddlers of dubious silver pills or shredded herbs? Yolisa Mashologu, an AIDS epidemiologist in the Lesotho government's health department, doesn't know. The one thing Lesotho does have, she says, is abundant unreliable information.
Mashologu lists some of the difficulties: cultural and ethical implications about death and sex make life difficult for researchers; a lack of funding for HIV/AIDS behavioural studies; "haphazard" data capturing from clinics targeting pregnant mothers or sexually-transmitted infections; the fact that many ill citizens distrust modern medicine and prefer to use traditional healers. What research there is - such as three large household surveys - had AIDS findings which varied considerably.
So she, like many researchers, looks at the death rates to try to decode the living. "It's logistically more practical," she explains. But getting the dead to speak on behalf of the living is a tricky business. Did this particular corpse perish because she knew about AIDS and didn't care, for example, or was she raped? South Africa's Shisana uses 'biomarkers', like syphilis rates, to measure changes in safe sex. If they go down, there is an indication that people are taking preventive measures."
A recent survey by the condom manufacturer Durex, which said there was a disconnect between what people knew, and what people did, greatly antagonised many AIDS researchers. Unscientific, they muttered. Internet-based, self-selected, a sneaky marketing attempt trying to pass itself off as legitimate science.
The Southern African country of Tanzania, on the other hand, has been trying its best to try to create some reliable methodology to assess whether people have changed their behaviour to protect themselves against AIDS, blanketing the country with demographic health surveys every five years. The results mimic the Durex response.
"Why is it that people are well knowledgeable of risky sexual behaviour but are not changing their behaviour?" mourns Dr Geoffrey Somi of the National AIDS Control Programme in Tanzania's main port city of Dar es Salaam. "Why a gap between knowledge and practices?"
In 2003, an intriguing nationwide Tanzania HIV Indicator Survey was conducted specifically for HIV/AIDS which covered many sexual behaviour indicators and showed a fairly high level of information. But while there is international donor money for prevention campaigns, condom distribution and in some cases, anti-retroviral drugs, there is little enthusiasm for funding research into sexual behaviour.
It gets even more complicated when researchers point out that something that may trigger helpful behaviour change in one sex, or in one age group, may slip past or even antagonise another subsection of the population.
"The needed information on sexual behaviour is indeed available," reports Somi. "However, the challenge that we see is not really lack of information or technicians but funds since such surveys are expensive."
The assumption seems to be that if you know better, you do better - but aren't assumptions made to be overthrown? Shisana, who previously worked in the South African government's health ministry, scans the complicated tables tracing the infection and is hopeful.
People "have begun to change their risky sexual behaviour," she says. "New HIV infections have decreased in the past years. South Africans are now translating their knowledge to action."
She credits multiple ways of changing behaviour, such as radio campaigns, easily available treatment for sexually transmitted diseases and free counselling and testing.
But some of the best ambassadors for changing high-risk sexual behaviour are in fact the people already infected with the disease. "The observation that many of their closest people are HIV positive and are dying also contributes to change in behaviour," Shisana confirms.
Sub-Saharan Africa has just over 10 percent of the world's population, but is home to close to two-thirds of all people living with HIV - some 25 million, according to the UNAIDS.
In 2003 alone, an estimated 3 million people in the region became newly infected, while 2.2 million died of AIDS, said the organisation.
--------------------------------------------------------------------------------
November 9, 2004
Posted to the web November 9, 2004
Christina Scott
Cape Town
The progress of the nasty little virus known as HIV can be monitored on its devastating journeys through bodies and communities. People's factual knowledge about the disease can be tracked. But getting more information in people's head does not automatically change their behaviour in bed.
This is very irritating for special interest groups who have already decided on people's sexual lifestyle. Anti-condom lobbies insist that people will be more tempted by pre-marital or extra-marital sex. Groups promoting safe sex are equally convinced that if people are given a condom, they will use it. But human beings refuse to fit into categories.
One study conducted among both urban and rural youth in the mountainous southern African kingdom of Lesotho uncovered a considerable number of teenagers who had noticed more AIDS and more condoms - and deduced that the latex must be the source of the virus!
Some scientists say it is only recently that they have recognised the importance of tracking sexual behaviour, citing intriguing declines in HIV infection, including Uganda and other countries in Africa. Are infection rates down because people are practicing safe sex, or because the infected have died? It is hard to tell, sometimes because the experts are so immersed in their technical language that it is hard to know what they are saying.
South Africa is often considered the epicentre of the epidemic. Even that causes the researchers conducting surveys to throw up their hands in dismay. "I never know what people mean with such broad statements," grumbles Rob Dorrington, director of the Centre for Actuarial Research at the University of Cape Town in South Africa. "We have the greatest number of infected individuals, which is a silly number since it depends on the size of the country. Botswana and Swaziland have much higher rates than South Africa, they just happen to be much smaller."
According to the 2004 Report on the Global AIDS Epidemic produced by UNAIDS, the average prevalence among pregnant women in Swaziland was 39 percent in 2002 - up from 34 percent in 2000 and only 4 percent in 1992.
In Botswana, antenatal clinic prevalence has been sustained at 36 percent in 2001, 35 percent in 2002, and 37 percent in 2003.
In South Africa, prevalence among pregnant women was 25 percent in 2001 and 26.5 percent in 2002, according to the UNAIDS report.
Many sexually active South Africans do not want to talk about AIDS. And those who do talk may not have very accurate memories. After all, if an intimidating retired hospital matron - the type used as field researchers in one national study - wanted to know if you had had unprotected sex, would you dare answer yes? "Self-reported changes in behaviour are never perfect," says AIDS researcher Dr Olive Shisana of South Africa's Human Sciences Research Council (HSRC). "They are subject to bias, to under-reporting."
"Personally, I don't even tell the truth when someone stops me in a shopping mall to ask questions about hair conditioner. I pick the answer that will get me away as soon as possible. If people will lie about political candidates and shampoos, why wouldn't they lie about sex?" she says.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) Reference Group on Estimates, Modelling and Projections knows that this is a tricky issue. They will meet in Harare, Zimbabwe, this month - Shisana will be among those attending - to provide advice on methodology. Their main advice: tread carefully. The problem is that for every solution, there are flaws. Test pregnant women, say some. Well, some women do not know they are pregnant for a good long time. Some pregnant women avoid clinics. Some use traditional healers. Not all women are pregnant!
In landlocked Lesotho the virus has reached into every rural village courtesy of a colonial-era economy which relies on the men leaving their farming families to mine gold in neighbouring South Africa. The Lesotho Development Bank has identified a long-term threat to the stability of the country: many children drop out of primary and high school because there is no money due to the illness or because they are needed to nurse the parents. The students do not return after burying them.
It is difficult to triangulate the infection, the changes in behaviour and awareness programmes, and anyone who claims it is easy is peddling something - either an ideology or a product. If your parent dies from AIDS, do you practice safe sex or resign yourself to a similar fate? Hunt for scapegoats or put your faith in roadside peddlers of dubious silver pills or shredded herbs? Yolisa Mashologu, an AIDS epidemiologist in the Lesotho government's health department, doesn't know. The one thing Lesotho does have, she says, is abundant unreliable information.
Mashologu lists some of the difficulties: cultural and ethical implications about death and sex make life difficult for researchers; a lack of funding for HIV/AIDS behavioural studies; "haphazard" data capturing from clinics targeting pregnant mothers or sexually-transmitted infections; the fact that many ill citizens distrust modern medicine and prefer to use traditional healers. What research there is - such as three large household surveys - had AIDS findings which varied considerably.
So she, like many researchers, looks at the death rates to try to decode the living. "It's logistically more practical," she explains. But getting the dead to speak on behalf of the living is a tricky business. Did this particular corpse perish because she knew about AIDS and didn't care, for example, or was she raped? South Africa's Shisana uses 'biomarkers', like syphilis rates, to measure changes in safe sex. If they go down, there is an indication that people are taking preventive measures."
A recent survey by the condom manufacturer Durex, which said there was a disconnect between what people knew, and what people did, greatly antagonised many AIDS researchers. Unscientific, they muttered. Internet-based, self-selected, a sneaky marketing attempt trying to pass itself off as legitimate science.
The Southern African country of Tanzania, on the other hand, has been trying its best to try to create some reliable methodology to assess whether people have changed their behaviour to protect themselves against AIDS, blanketing the country with demographic health surveys every five years. The results mimic the Durex response.
"Why is it that people are well knowledgeable of risky sexual behaviour but are not changing their behaviour?" mourns Dr Geoffrey Somi of the National AIDS Control Programme in Tanzania's main port city of Dar es Salaam. "Why a gap between knowledge and practices?"
In 2003, an intriguing nationwide Tanzania HIV Indicator Survey was conducted specifically for HIV/AIDS which covered many sexual behaviour indicators and showed a fairly high level of information. But while there is international donor money for prevention campaigns, condom distribution and in some cases, anti-retroviral drugs, there is little enthusiasm for funding research into sexual behaviour.
It gets even more complicated when researchers point out that something that may trigger helpful behaviour change in one sex, or in one age group, may slip past or even antagonise another subsection of the population.
"The needed information on sexual behaviour is indeed available," reports Somi. "However, the challenge that we see is not really lack of information or technicians but funds since such surveys are expensive."
The assumption seems to be that if you know better, you do better - but aren't assumptions made to be overthrown? Shisana, who previously worked in the South African government's health ministry, scans the complicated tables tracing the infection and is hopeful.
People "have begun to change their risky sexual behaviour," she says. "New HIV infections have decreased in the past years. South Africans are now translating their knowledge to action."
She credits multiple ways of changing behaviour, such as radio campaigns, easily available treatment for sexually transmitted diseases and free counselling and testing.
But some of the best ambassadors for changing high-risk sexual behaviour are in fact the people already infected with the disease. "The observation that many of their closest people are HIV positive and are dying also contributes to change in behaviour," Shisana confirms.
Sub-Saharan Africa has just over 10 percent of the world's population, but is home to close to two-thirds of all people living with HIV - some 25 million, according to the UNAIDS.
In 2003 alone, an estimated 3 million people in the region became newly infected, while 2.2 million died of AIDS, said the organisation.
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alex.arch - 10. Nov, 20:47
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