ALQ,November 2006 Edition - HIV Prevention

Editorial...

To be effective, HIV prevention programmes must address the context in which people live their lives… [UNAIDS 2005]

It is within the context of acknowledging the inadequacy of existing HIV prevention strategies, and recognising the need for effective HIV prevention strategies that this issue of the ALQ explores a variety of HIV prevention realities and challenges.

The various articles in this edition examine a range of challenges to HIV prevention, as well as various realities in which HIV prevention occurs. Barriers to HIV prevention, such as stigma, culture, values and norms, the societal context, including the ‘unsafe’ environment for HIV prevention and disclosure; the failure of HIV prevention strategies to cater for the needs of lesbian and gay people, ‘the elderly’, and people living with HIV; as well as the power of language are some of the issues explored in this issue.

The integral features included in this edition of the ALQ look at HIV prevention challenges in Kabokweni, Mpumalanga; introduce various behavioural change communication strategies employed in the SADC region; and ‘make a point’ about fertility desires of people living with HIV. This issue also includes a ‘feedback’ on HIV prevention challenges, debates and insights from the provinces.

In this edition, Felicity Harrison examines the potential of HIV disclosure as one of the HIV prevention strategies. Exploring the pros and cons of promoting HIV disclosure, she argues that even though HIV disclosure should be the norm and ‘best case scenario’ for effective HIV prevention, reality does not provide an environment in which people can ‘safely’ disclose their HIV status.

Recognising the apparent failure of HIV prevention, Johanna Kehler raises the question as to whether or not HIV prevention strategies and messages coincide with the societal context in which prevention occurs. She examines various barriers to HIV prevention and argues that as long as HIV prevention strategies and messages fail to take into account people’s lives and are not based within the context of behavioural change, stigma will continue to be the main barrier to HIV prevention.

The accessibility of HIV prevention for lesbian and gay people is discussed by Fikile Vilakazi. Analysing lesbian and gay people’s prevention needs and experiences in accessing prevention methods, she argues that existing HIV prevention strategies not only exclude lesbian and gay people, due to the failure to encompass the diversity of sexual behaviour, but only ensure that lesbian and gay people remain to be the ‘others’, who are on the fringes and margins of society.

Acknowledging the ‘power of language’, Derrick Fine examines how language, and being seen as ‘different’, impacts on attitudes and actions around HIV prevention and treatment. He analyses the change from the ‘stigmatising stain of language’ and its influence on HIV and AIDS communication in South Africa to ‘the power of positive language’ and argues that using positive, affirming language around HIV is not about political correctness, but about shifting attitudes, beliefs and policies.

In view of growing HIV infection rates amongst ‘the elderly’, Emma Harvey explores whether or not HIV prevention strategies are reaching people over 50. Looking at the considerations given to people over 50 in HIV prevention and exploring the existing stereotypes and myths about ‘the elderly’, she argues that people over 50 remain largely invisible and ignored in HIV prevention strategies, due to age-related stigma and discrimination.

The need for adequate and accessible prevention of mother-to-child transmission programmes is addressed by Busisiwe Maqungo. Reflecting on personal experiences with both the lack of, and the availability to, PMTCT programmes, she argues that PMTCT is an imperative for realising the constitutionally guaranteed right to live.

The need to address influences that taint HIV prevention messaging is highlighted by Mduduzi Mthembu. Looking at gender, gender violence, culture and norms, as well as stigma and prejudices as some of the factors influencing the ‘success’ of HIV prevention messaging, he argues that effective HIV prevention strategies need to cater for everyone and promote values of unity, instead of diversity.

Suzanne Leclerc-Madlala analyses the sociological and gender context of HIV prevention in Southern Africa. Identifying various influences contributing to this context, she discusses custom and tradition, historic processes and modern trends; and argues that the sociological and gender work required to make a real impact on HIV and AIDS in the region is nothing short of substantial.

The challenges facing HIV prevention programmes in Kabokweni, Mpumalanga are introduced by Sipho Fakude. Discussing some of the realities and experiences from a service provider’s perspective, he argues that for HIV prevention to be successful, personal attitudes and behaviours need to change before HIV prevention strategies and programmes can be rolled-out into communities.

Behaviour change communication strategies, as a means to help young people ‘avoid HIV and AIDS’, are introduced by Kent Klindera. Analysing the successes and obstacles of various strategies and programmes in the SADC region, aiming at behaviour change amongst young people, he argues that the ‘key to success’ in effective youth specific behavioural change communication strategies lies in multi-faceted programmes with consistent messaging that involve young people.

Discussing fertility desires and sexual and reproductive health needs of people living with HIV, Dorothy Odhiambo is ‘making a point’ about the lack of considerations given to these desires and needs at policy level, programme design and service provision. Exploring some of the obstacles experienced in accessing services, she argues that it is of utmost importance for policies to be explicit about, and inclusive of, sexual and reproductive health rights of people living with HIV, so as to prevent the violation of rights.

Irrespective of which one of the many HIV prevention realities and challenges have been examined, there seems to be the commonly raised question as to why HIV prevention does not seem to work, does not seem to prevent new HIV infections, and does not seem to protect people, who are vulnerable and at risk, of HIV infection. While the answers may vary in approaches and ‘targets’, common is a call for ‘change’ towards effective prevention strategies and programmes, which are, indeed, responding to people’s prevention needs and which are applicable to the lives of people in need of HIV prevention.

Some may argue that HIV prevention messages need to ‘change’, so as to cater for the needs of a specific ‘target group’ and/or that the ‘target group’ need to ‘change’ so that HIV prevention messages can work. Yet, others may argue that effective HIV prevention strategies and programmes are about ‘change’ – not ‘change’ in ‘target’ and/or ‘message’, but ‘change’ in the environment, internal and external, in which HIV prevention occurs; ‘change’ in attitudes and ‘mindsets’; and ‘change’ in behaviour. Whatever the preferred ‘target of change’, the common challenge seems to be the individual and collective ‘reluctance and resistance to change’ – based on, justified by, and excused with, the well recognised ‘barriers’ of culture, religion, value, norm and belief systems and ‘that’s the way it is’, leading to stigma and its subsequent discrimination.

If we are to agree that there is a dire need for ‘change’ towards effective HIV prevention, then there is a need to acknowledge that HIV prevention strategies and programmes can, and only will be, effective as and when ‘targeted’ at people. Not, because people are of a certain age, profession, mobility and/or sexual orientation, but because people are sexual beings. Only as and when we understand the ‘target group’ to be people, who are sexual beings, and who live lives filled with diverse contexts, desires and needs, will we be in the position to understand prevention needs and begin to develop and implement HIV prevention strategies and programmes that are responsive to the context in which prevention occurs.

So, if we are to ‘remove the barriers’ to HIV prevention, so as to ensure that HIV prevention is accessible, available and beneficial to everyone, and that HIV prevention ‘addresses the context in which people live their lives’, then there is a need to ‘change’ and ‘change’ then seems imperative to HIV prevention. A need to ‘change’ existing concepts of ‘prevention needs’ and perceptions of ‘how people live their lives’; a need to ‘change’ understandings of ‘risky behaviour’ and ‘high risk groups’; and a need to ‘change the unsafe environment’, filled with stigma, marginalisation and exclusion of ‘the other’, into an ‘enabling environment’ of inclusion and respect of ‘the other’.

Besides a need to ‘change the external environment’, there is an equally dire need to ‘change the internal environment’, the ‘people’, who sustain and maintain the ‘external’; a need to ‘change us’, as people who create ‘the other’ and are part of ‘the other’; as people, who ‘target high risk groups’ and ‘address high risk behaviour’, while being at ‘high risk’ through engaging in ‘high risk behaviour’.

Only as and when ‘change happens’ at both levels, will HIV prevention strategies and programmes finally be in the position to offer ‘real’ options of prevention. Thus, until we ‘change the barriers’ preventing prevention, ‘change people and people’s lives’ upholding the very same ‘barriers’, and ‘change us’, HIV prevention efforts will continue to fail, remain ‘meaningless’ and provide no real means of preventing the risk of HIV infections – neither for ‘the other’, nor for ‘us’. Johanna Kehler