Grass roots campaign needed for HIV prevention
- new UNAIDS country director By Oluatoyin Alleyne
Stabroek News
November 7, 2006

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For more success in preventing HIV/AIDS there is a need to move away from the traditional glossy poster campaigns and get down to the grass roots to learn how to shape messages for specific groups.

This was the warning sounded by Guyana's new Country Director for the Joint United Nations Programme on HIV/AIDS (UNAIDS) Dr Reuben del Prado who said that Guyana would be addressing this issue in its new HIV/AIDS National Strategic Plan for 2006/2007.

Dr del Prado told Stabroek News in a recent interview that in the last three years, worldwide, the focus has been on treatment which is very important while prevention has slipped a "little bit" because of the global international focus on expensive intervention.

"On the other hand we have tried in many countries to make people aware of HIV using traditional ways of education, posters, brochures, but you know what, posters and brochures don't prevent HIV."

Stating that he is "very innovative when it comes to prevention", Dr del Prado suggested that for better results in preventing the disease discussions should be had with behavioural scientists, anthropologists and some young people to find out how the country can get rid of quite a few misconceptions.

He said prevention of the commonest type of HIV transmission has to do with sex and unfortunately human sexuality makes it tricky because sex is not something people openly talk about. "We are doing it, lots of it but we don't like to talk about it. On the other hand sexuality has been used over the years by a number of cultures, including the culture that we have here in Guyana, as a means of controlling… controlling people's behaviour, controlling people's lives."

He pointed out that this dates back to slavery and Queen Victoria, the old Victorian things that have slipped into cultures and the bad and sour fruits are now being reaped.

"In all those countries where people openly talk about sexuality and make condoms freely available, and commercial sex legalised, when men having sex with men are not penalised and stigmatised, the rates of HIV/AIDS are the lowest," Dr del Prado said.

On the other page, those countries where "people are screaming hell and damnation" about sex and people don't talk openly the rates are the highest.

Dr del Prado, who is a behavioural scientist as well as a medical doctor, said the scientific evidence is available to show which programmes are successful and which are not.

"And a number of the most unsuccessful programmes of prevention in the world are expensive, they are glossy, they have the most beautiful posters and brochures [but] they are the most unsuccessful programmes," he said. He further stated that the unsuccessful programmes' annual reports are the most beautiful and they are widely distributed and read, but people continue to be infected.

The scientist posited that there is need to sit and have discussions with the people for whom the programmes are intended.

"We have to get out of our offices and out of our rooms and stop sitting behind out computers writing prevention programmes, we have to go to the specific people, be they young, middled age or aged, sit with them and have them tell us… what is the risky behaviour happening in [their] age groups, families, schools, communities…that put people at risk."

He noted that risk taking behaviours are exciting and no one talks about the pleasure of risk taking, they always talk about the bad things.

"We have to turn it around and talk about the pleasures of risk taking behaviours and how much of this pleasure are [they] willing to sacrifice and based on the sacrifice of that pleasure we would develop a programme…" He said people should be told that no one wants to take away their pleasures and excitement but there is HIV and other Sexually Transmitted Infections (STIs) and they could work along to help prevent them.

"This is the only thing that works, it is done too little, it works because it is logical…"

Dr del Prado spoke about the 'faith healers' who have been claiming to heal persons of HIV/AIDS and stated that they are actually preying on the weakness and despair of people who are afraid and desperate to stay alive.

"To promise them healing is very disappointing because if the healing is there why are there more infections? If the healing works then why is the number of HIV infections going up? If the faith healers are really healers then let them come forward and heal so I can go home early and watch a movie…"

Strategic plan

UNAIDS has been working with the Ministry of Health and other partners to develop the new strategic plan for next year.

"So unlike many countries when 2007 starts we have a programme for the next five years ready," he said.

According to him the plan will have four pillars, which are based on the three 1's principles: one agreed HIV/AIDS action framework for coordinating the work of all partners; one national AIDS coordinating authority, with a broad based multi-sector mandate; and one agreed country-level monitoring and evaluation body and the national coordination of HIV prevention, treatment, care and strategic information.

He said that the prevention pillar is something that UNAIDS is extremely interested in supporting and as such all the players in the HIV/AIDS fight need to harmonise in this area. Dr del Prado, who has worked in India, Uganda, Switzerland and out of Trinidad, said UNAIDS would also work with the government in fine-tuning coordination which is part of its mandate. He said Guyana has been receiving a lot of funding and it is important that it is channelled in the right areas

"Guyana is not just Georgetown, we have to go to the hinterlands, we have to go to the hard-to-reach areas, we have to go that hard-to-reach population. There are the miners, there is sex work happening, there is the issue of mobile population, there is the issue of men having sex with men as a behaviour… it is every important to address the issues and give proper information..." Describing himself as the "new kid on the block", Dr del Prado said the coordination part of the programme needs some work and it is not just him saying so, but the people from the Ministry of Health and other UN partners have stated that they are looking towards UNAIDS to assist in tweaking that component.

"I have just been in India, a country with 1.2 billion people. This country has 700,000 people and the coordination should be so simple, except a small country does not mean easy. [In] a small country the personality… the importance of people… becomes a little bit more obvious. [But] UNAIDS is not in the business of dethroning the kings and the queens and taking away people's positions… we are in the business of making sure that there is transparency and understanding and accountability to the national authority, which is the Presidential Commission on HIV/AIDS."While commending Guyana on having such a commission, Dr del Prado said what needs to be looked at is what comes after the commission.

He suggested that the partners in the HIV fight be united in a platform or partnership that together they can meet once a month and tell each other what they are doing and then every two three months report to the commission.

"This would help the three 1s approach…" he said.

He feels that Guyana can serve as a model for any country. He commended the government for "doing things" in the area of HIV/AIDS and one of the most important areas that they have been working in is making people aware of HIV/AIDS.

He said the Ministry of Health has not been treating HIV as a separate issue when it comes to the quality of life but rather making sure that HIV is addressed as part of several services provided to the general public in public health. He mentioned the number of voluntary counselling and testing sites (VCT) sites in Guyana and the decentralisation of HIV with a number of regional services becoming involved in the fight. He noted too that everyone who is clinically ready for treatment can receive anti-retroviral (ARV) drugs free of charge.

UNAIDS is a secretariat and a programme which is the coming together of ten UNAIDS agencies to ensure that the UN family addresses the issue of HIV/AIDS in a professional and comprehensive manner.

There is an estimated 12,000 Guyanese living with HIV and as at February of this year some 4,000 persons were in need of ARV treatment, according to the Centers for Disease Control and Prevention (CDC). As of September this year 1,546 individuals have been receiving treatment (350 more than ten months ago).