Africa’s AIDS fight: Fresh focus on issue of multiple partners
New research is leading to new prevention programs focused on cultural change.
JOHANNESBURG, South Africa
In the latest season of the popular South African television show, Soul City, Zanele presents her husband with a box of condoms when she discovers he's been cheating.Skip to next paragraph
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If he won't be faithful, she says, they'll have to use protection.
When he storms out, Zanele's mother chides her for making a fuss, saying all men have other women.
"Well, times have changed, Ma," says Zanele. "There is a thing called HIV now."
The show, produced by a South African nongovernmental organization, is representative of a revolutionary new generation of AIDS prevention campaigns that reflect a growing recognition that condoms aren't enough and that slowing the epidemic will require widespread cultural change. The new approach, which is being pioneered in South Africa, targets initial practical steps on route to that broader goal. It is based on new research about the driving forces of the epidemic – specifically the common practice in many hard-hit African countries of having multiple, long-term sexual partners at the same time.
These new AIDS prevention messages are also blurring the often-rancorous divide between largely secular advocates of condom-based messages and religious organizations that emphasize abstinence and fidelity.
The US President's Emergency Fund for AIDS Relief (PEPFAR), George W. Bush's multibillion-dollar global HIV/AIDS program, was initially heavily criticized by many secular AIDS activists for its requirement that a third of all prevention funds be spent on abstinence-until-marriage programs.
"We've moved beyond ABC," says John Molefe, a senior executive at the Soul City Institute that produces the Soul City drama, referring to the traditional Abstinence-Be Faithful-Condomize model that has shaped AIDS prevention for decades. "We've learned that behavior change is a lot more complex than we thought."
New research, new programs
South Africa's approach is catching on: on Nov. 28, UNAIDS called on countries to bring their HIV/AIDS prevention programs in line with new research. On Monday, the United Nations marks World AIDS Day for the 20th year.
AIDS prevention has been on the back burner in recent years, as attention – and money – shifted to providing treatment to those already infected.
Many had lost faith in prevention programs, which seemed to be a black hole that sucked up millions of dollars of funding but did little to slow the epidemic's growth. But now many experts believe the messages didn't fail, they just didn't target the right behaviors.
Traditionally, AIDS prevention messages were driven by the belief that if people knew about HIV/AIDS, they would take steps to protect themselves. Now, there's new understanding that knowledge isn't enough and condoms alone won't stem the tide.