Ncayiyana, Daniel J

English

South African Medical Journal (SAMJ)

Five million South Africans are infected with HIV. The questionof whether, what and how best to provide treatment andsupport for those living with AIDS has come to monopoliseattention, dominate debate and consume the greater part of thenational effort to deal with the pandemic. This is understan-dable, given the critical events and controversies that haveintervened in this regard. Treatment is an indispensablecomponent of the war against the virus, and contributes toreducing the rate of transmission. There are 40 million South Africans who are free of HIVinfection, but one hears little noise or agitation about keeping itthat way. Prevention was a ‘sexy’ topic while there were heateddebates about causation, abstinence, condom use and so forth.Now it has become boring for the media, and the treatmentbandwagon appears steadily to be drowning out prevention asa campaign issue. The opportunities for youth-focused preventioneffortsEvery day 7 000 young people worldwide become infected withHIV, and overall young people constitute 50 - 60% of those whobecome infected after infancy.1 For this reason, UN agencies andother bodies concerned with HIV prevention underline theimportance of focusing prevention strategies on youth. In apersonal communication, David Harrison of loveLife points outthat ‘the huge opportunity rests in the fact that virtually all 13-and 14-year- olds are HIV negative (as we speak). If newgenerations of young people could stay that way, the futurecourse of the epidemic can be determined within 5 to 10 years.’Furthermore ‘In South Africa, only one in 30 (3.2%) 15-year-olds is HIV positive. If they and those following them were togrow up largely uninfected, the rate of infection could behalved by 2010 and the overall prevalence would declinesteadily over the next 15 years. Coupled with an effectiveantiretroviral treatment programme, there are very realprospects for substantially changing the course of theepidemic.’However, it is clear that to be effective, the youth campaignhas to be creative and innovative. The old approach of scaretactics and cathedral-style sermons will no longer do. Harrisonand his colleagues have faced criticism for loveLife’s approachof billboards, slogans, youth clinics with ‘chill rooms’, schoolsports, youth leadership programmes and positive self-imageinitiatives. But they are trying to reach out in a manner thatspeaks to the youth, and there is evidence that they are havingan impact in getting South Africans to talk more openly aboutsex and providing thousands of schoolchildren with effectiveknowledge of HIV, and further that the infection rate is loweramong those who have been exposed to their programmes.2Prevention not conditional upon poverty alleviationPoverty and unsanitary conditions in slum environmentsconstitute fertile ground for debilitating illness, sexuallytransmitted diseases and facilitated transmission of the virus.HIV-positive youth are significantly less likely to havecompleted high school and to have a job, and are more likely tohave grown up in environments with no opportunities forsocial diversion. Children raised in ‘sexually charged’environments where they regularly witness adult sex incommunal one-room shacks are themselves apt to indulge inearly sexual experimentation. Poverty alleviation is not a sine qua non for an effectivecampaign. There are ample examples of poverty-strickencommunities around the world with little or no HIV prevalence.According to Harrison, what we need to do is tackle deeplyentrenched norms in South African society – the subordinatestatus of women and girls, the toleration of sexual coercion, andthe avoidance of family discussion about sex and sexuality.Early sexual debut is not unique to South Africa. Exceptwhere strictly regulated by tradition or religion, early sexualexperience has become the norm in most countries. In the UKand the USA most youth have experienced sex by the time ofgraduation from high school. In Australia ‘the majority ofyoung people in Years [grades] 10 and 12 are sexually activeand this has increased over the last decade’ and ‘mostAustralian teenagers do not practise safe sex’.3What is unique about South Africa is the prevalence of sexualcoercion and sexual violence, power inequalities between boysand girls, and multiple-partner sexual relationships. We shouldinvest money and effort in gettingrid of these practices and in thecontext of a revitalised preventioncampaign get our youth to thinklike Mattla, the 14-year-oldAmerican boy in DeborahTolman’s study, who says ‘I usedto like girls that would just, like,do stuff and everything, likemaking out … but now I like tohave a relationship with girls.’4Daniel J NcayiyanaEditor1. Force for Change: World AIDS Campaign with Young People.www.scouting.org.za/resources/ aids/youthcampaign/html (accessed 12 November 2005).2. Is loveLife making them love life? www.mg.co.za/insight_comment_and_analysis 24 August2005 (accessed 12 November 2005).3. Healy J, ed. Teenage Sexuality. 2005. ISBN 1 920801.www.spinneypress.com.au/221_book_desc._html (accessed 12 November 2005).4. Kott A. Findings: Teenage sexuality.www.fordfound.org/publications/ff_report_detail_cfm?report_in... (accessed 12 November2005).SOUTH AFRICAN MEDICAL JOURNAL –FIRST PUBLISHED JANUARY 1884December 2005, Vol. 95, No. 12 SAMJPrevention, not treatment, remains the Holy Grail forwinning the war against HIV and AIDS899Pg 899 q5  25/11/05  12:18 pm  Page 899

Prevention, not treatment, remains the Holy Grail for winning the war against HIV and AIDS

http://samj.org.za/index.php/samj/article/download/1907/1224

Prevention, not treatment, remains the Holy Grail for winning the war against HIV and AIDS

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South African Medical Journal (SAMJ)