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Siyayinqoba Beat It! Episode 17 -

HIV communication strategies

In this weeks episode of Siyayinqoba Beat It! 2006 we took a look at South Africa's current response to HIV prevention; ABC. ABC stands for Abstain, be faithful and condomise. There is a need to re-think this approach because South Africa's HIV infection rate is still on the increase despite our prevention efforts. The latest antenatal survey showed that over 30% of pregnant women are testing HIV positive and six million people are now living with HIV. Clearly, ABC is not working. We hear what Mrs. Mnguni, a guidance teacher from Daveyton and her pupils have to say about HIV prevention strategies. We also headed to International Microbicides Conference to hear the thinking there.

Shalom Ncala: Sanibonani, siyani amukela eqenjeni leSiyayinqoba Beat It! support group. Ingama lami ngingu Shalom Ncala. Eqenjeni loSiyayinqoba Beat It! sonke siphila kahle ne-HIV. Sanibonani nonke. Ninjani kodwa nahlanje. I viki ne viki siyahlangana ukuzo xoxisana ngezindaba ezithinta izimphilo zethu, ukusuka ekusebenziseni amacodom ukuya ukusebenzisa izidakamizwa ngokunga fanele kanye ne-HIV. USiyayinqoba ngu hlelo lwakho lokhu phila kancono nge HIV.Uma uphila negciwane le-HIV, noma unomlingani, ilunga lomdeni noma umngani ophila negciwane le-HIV. ISiyayinqoba yenzelwe wena. U-ABC usho ukuthi zila ukuya encansini, yethembeka usebenzise necondom. Lena yimpendulo yase South Afrika yokuvikela i-HIV. Kukhona isidingo sokhucabangisisa ngaleli liso ngoba isilinganiso sokuthelelana sokubakhona kwe HIV eNingizumu Afrika siyanda nanoma kuyenziwa umuzamo yokusivikela. Kamuva izivivinyo zasemakliniki sabomama abakhulelwe zivezwe ukuthi inani elingongo 30% kwabantu besifazane abakulelwe banegciwane le-HIV futhi u-six million yabantu lenegciwane le-HIV. Lokhu kusibonisa ngokugwele ukuthi uABC akasebenzi. Masilaleleni ukuthi yini eningakusho ngamasu okuvikhela i-HIV. {IsiZulu} [Hello and welcome to the Siyayinqoba Beat It, support group. My name is Shalom Ncala. In the Beat It! support group we are all living positively with HIV. Hello everyone. How are you all today? Each week, we get together to discuss issues that effects our lives with HIV, from using condoms to substance abuse and HIV. Siyayinqoba is your guide to better living with HIV. If you are living with HIV or you have a partner, a family member or a friend who is living with HIV Siyayinqoba is for you. ABC stands for Abstain, be faithful and condomise. This is the South African response to HIV prevention. There is a need to re-think this approach because South Africa’s HIV infection rate is still on the increase despite our prevention efforts. The latest antenatal survey showed that over 30% of pregnant women are testing HIV positive and six million people are now living with HIV. Clearly, ABC is not working. Let’s hear what you have to say about HIV prevention strategies.]

QUESTION: I-South African Prevention plan ayisebenzi, e-South Africa sizokwezani kulominyaka eyi-five ukweza ukuthi isebenze.{IsiZulu} [What is South Africa’s plan for an HIV prevention strategy that works?]

Shalom Ncala: Iqembu lethu liyelaya e-Unity High School eDaveyton. Sahlangana notisha we guidance u-Mrs. Mnguni oyeanikhela iclass ulwazi ngephilo. Siphende sakhuluma futhi nabafundi ukuthi bazizwa kanjani ngomkhakhaso we ABC. {IsiZulu} Our team went to Unity High School in Daveyton. We met the guidance teacher, Mrs. Mnguni, giving a life orientation class. We also spoke to the learners about their feeling around the ABC campaign.

Daveyton, Gauteng, 'How effective is the ABC campaign?'

Narrator: ‘The South African government adopted the ABC campaign as its main preventative strategy in 2003. The ABC approach was developed by the US Agency for International Development, USAID, based on Uganda’s success in reducing HIV prevalence.

Sibongile Mnguni: Umsebezi enguwuyenzayo u-involver izinto eziningi la ku-life orientation. Sifundisa futhi nange AIDS siyafundisa ngayo, nange STIs ama sexual transmitted infections. Abatwana fanele bakwazi ukuthi i-risk yokulala iletha ini eziphilwenizabo. {IsiZulu} My work in the Life Orientation class involves many other aspects. We also provide education on the AIDS and sexually transmitted infections. Children need to know of the risks involved in having sex.

Sibongile Mnguni: [How can we prevent ourselves from contracting HIV/AIDS?] {Sesotho}

Young boy Pupil: [We can prevent it by being faithful to one partner.] {Sesotho}

Teacher: What he means is B, ne, being faithful. B stands for, ‘Be faithful’, C stands for, ‘Condomise’

Sibongile Mnguni: The ABC programme works, but we only move on to the ‘C’ after we’ve exhausted all other methods of prevention.

Naledi Pandor, National Minister of Education: I think in this modern age, one would ask, given the availability of measures for protection against pregnancy, why are young people failing to use these? They’re clinically accessible, there are more and more clinics, maybe we need to think of youth clinics, youth centres, so we need to perhaps be more responsive to the problems we’re identifying. And our concern is, we always trot out just one solution, ABC, condomise, instead of saying to young people, ‘Do you know that actually if you engage in sexual activity, you can take these steps, and you do not have to become pregnant, you can take these steps, and you will protect yourself from becoming HIV positive. Use a condom’. I mean, we say it, but people want us to hand condoms to children, and I’m not sure what message they would be asking us to be sending with respect to that.

Young girl pupil: [What I’m saying is that the ABC strategy is not working. Young people are still being infected with HIV/AIDS and falling pregnant]. {Sesotho}

Young boy pupil: [For this programme to work, we need to actually practice it.] {Sesotho}

Young girl pupil: [I can understand the abstinence part, but to condomise, I don’t get it.] {Sesotho}

Young boy pupil: At least you have to be protected in a way, it another form of saying prevention, [do you hear what I’m saying.] {Sesotho}

Young girl pupil: [So are you saying its fine for condoms to be available at schools?] {Sesotho}

Young girl pupil: Prevention is better than cure. It’s better to protect these kids, let them be on the safe side, instead of exposing them to HIV/AIDS, because if condoms are not distributed at schools, these kids are definitely going to get infected. We can’t stop them; the better thing is that we protect them by giving them condoms. We’re not promoting it, but we’re playing it safe.

Naledi Pandor: And the young people must exercise the responsibility, must be the ones who ensure they protect themselves.

Young girl pupil: [Now that we’ve heard your opinions, how many of you are abstaining? Ok, we see those who are abstaining. Who of you are 100% faithful? How many of you use condoms? Okay, I can see that none of you are condomising, so who’s sexually active?] {Sesotho}

Someone: So you don’t use condoms?

Young boy pupil: Hayi angiyisebenzisi i-condom. {IsiZulu} [No, I don’t use condoms].

Young girl pupil: [I see that most of you are not using condoms when having sex, that’s why I saw the ABC method is not working. If it was working you’d be using condoms and free from the dangers we’re faced with. Simple.] {Sesotho}

Naledi Pandor: We need to ask ourselves what more, beyond ABC, how do we strengthen the impact of that message, so that young people are so alert to the issue of prevention that in fact they guard their status of negative HIV.

Support group

Shalom Ncala: In essence yebo mina ngiyasho ukuthi ngisavela ngiya steyitor ukuthi i-ABC ngeke isebenze. Angazi ukuthi abanye abantu bafila kanjani ngalento. {IsiZulu} [In essence, I maintain that ABC will never work. We need to have better interventions. I don’t know how other people feel about this.]

Busisiwe Maqungo: If you look at this graph from 1990 to 2005, the number of infections never went down, it’s constantly been rising. Now it shows that 30% of new infections are in women… that is every 30 women out of a hundred women are infected with HIV. That tells us that ABC is not working.

Vuyani Jacobs: I would agree that we say, based on the communication strategies around ABC, it does not work, but I do not believe that we cannot build up on the existing strategies and I don’t think that we should brush them as not working, because abstinence does work for several people, saying that they abstain. I would rather skip ‘be faithful’ and go to ‘condomisation’.

Nokhwezi Hoboyi: Ndiphinde ndiku-supporter lulento yakho ukuthi ABC angasebenza with the right information. I-communication ne sex education needs to happen at school not lento u-Naledi Pandor ayishoyo. Banikhe amacondom, banikhe wonke ama options abatwana, ukwenzala ukuthi ukuthi umuntu azikhethele not half the options ngoba the minute uzomu limithela ama options uzozibuza ukuthi oh why? {IsiZulu} [I support you when you say ABC can work with the right information. Sex education needs to happen at schools, not what Naledi Pandor is saying. Give them condoms, give them all the options, because once you limit their options, they’ll start to experiment.]

Vuyani Jacobs: That’s why we must not use broomsticks; we must not use bananas, to show penises. People must talk about how it feels when a condom is very nice and tucked into it. People must understand of the nice feeling of a condom and sex, and how nice that is. If that is part of our skills education around condom use, that will work. You cannot talk about these things in a formal education like that, because the policy does not allow you.

Thami Mthenbu: 70% of new infections are in people who are in a committed relationship, and some times we as men we have our thinking of rationalizing things. And I think sometimes when we say ‘be faithful’, we also need to define what we mean by ‘being faithful’,because I know men who would say, Hayi ngoba ngila ngi faithful la, noma abuya kuNokhwezi [I’m faithful here because I am here, I’m also faithful to Nokhwezi] back home. It’s the reality. So nangu osisi Nokhwezi uziphethe kahle mina ngilapha Egoli ngiyaxhumaxhuma six months down the line ngiyabuya ngizothelela losisi ohleli la. {IsiZulu} [So while Nokhwezi was being faithful to me, I was not. Six months down the line, I come home and infect her.]

Fanie de Villers: [Do you think we have enough messages to target everybody? Are we really including sex workers with ABC? There are migrant mine workers, does ABC include them? Do we have enough messages?] {Afrikaans} That is something a thought about, I just want to throw the question to the group, because I will love what you think about it.

Busisiwe Maqungo: I-message endiyinikha ubhuti oquba i-truck, o-driver from Cape Town to Namibia might not work for umntu oyi-sex worker uyayiva lento endizama ukuyithetha. I think enye yezi-strategies esifanele siyingenisileyo i-group ethile ifumane i-message ethile. {IsiXhosa} A message directed at a truck driver might not work on a sex worker. I think that’s the strategy we need – different messages for different people.

Shalom Ncala: [We talk more about HIV prevention strategies after the break. Stay with us.] {Sesotho}

Shalom Ncala: [Welcome back to the Siyayinqoba Beat It! support group.]{Sesotho}. Uhlelo lawonke umuntu uthelekayo nonomthelela weHIV. Namhlanje si amukela u-Wayne Alexander ovela e-John Hopkins Health Education e-South Africa. Siyakwemukela Wayne. Iqembu leSiyayinqoba liyelaya enqunqutheleni yamazwe gamazweni yama Microbicides ka 2006 ukuyobona ukuthi kuyoxoxosana ngamaphi amasu wokhuvikhela.{IsiZulu} [The programme for everyone infected and affected by HIV. Today we welcome Wayne Alexander from Johns Hopkins Health Education in South Africa. Welcome Wayne. The beat it team went to the 2006 International Microcides conference to see what prevention strategies they discussed.]

Cape Town, Western Cape,

International Microbicides Conference, 2006, Convention Centre.

Narrator: The first microbicide conference on African soil was held in Cape Town in 2006. Microbicides are substances which can be applied to the vagina or rectum to prevent the sexual transmission of HIV and other STDs. At present, an effective microbicide is not available. The conference also discussed other intervention, such as ABC, Post Exposure Prophylaxis, circumcision and our response to gender violence.

Graca Machel: Despite the huge investment we have made on HIV prevention, little has changed. The existing methods to prevent HIV infection are failing many women. Asking women to simply abstain, be faithful, or use condoms is not possible. For too long we have paid lip service to gender equality, and have shown modest results. Our efforts have been insufficient and inefficient, and we have shown a lack of urgency in creating a more equal society.

American woman: The current quality of gender relations gives women little power to negotiate protection against this disease.

Mark Heywood: We will recommend that every person in this country, young and old, but especially young people should test for HIV. All of us should know are we positive, or are we negative.

Dr Francois Venter, HIV specialist: From a biological perspective, there is now more evidence for this intervention than probably any other biological intervention for making it better. Circumcision would decrease the rate of HIV by 70& over an 18 month period. That’s better than any of the most ambitious projections for what a vaccine’s going to do.

Graca Machel: We can no longer remain silent when our sisters face sexual violence, rape and female genital mutilation. We can no longer stand for discriminatory laws that dim women as minors. We must hold our governments and institutions accountable for the decisions they make or they fail to make

Support group

Shalom Ncala: Wayne, If we have to refer to insert that we have just saw, what is your take on gender violence and women empowerment questions that is coming out with in that insert?

Wayne Alexander, Johns Hopkins University: What we’re learning is that we need to do more around prevention, that simply ABC is not enough. Gender has always been an issue, and something that we need to work harder at. We’ve been speaking about youth and youth and youth, and I’m tired of young people, because if you look at the stats, who are young people sleeping with, who are the infected? Its young women that there’s high rates of infection, and older men there’s an increase in infection. And what is our messaging saying? Love life is speaking to young people and what are we saying to older men. There are no messaging targeting older men.

Shalom Ncala: I know for a fact that older men go for younger women simply because they think they’re ‘fresh’, they’ve never been tarnished before, they are untouched, whatever, forgetting that throughout their life they’ve been engaging in sexual activity with all types of ages. Now, simply because there’s HIV, they want to go back, and go back to the virgins that haven’t been touched before. And what that does, it increases it from the other end now to your young people.

Wayne Alexander: Our society says a women’s role is to please men. We aren’t speaking to men, because they’re difficult, they’re hard to talk to, but we need to start doing that. So its part of how we start reprogramming and redesigning our programmes, we need to speak to all the people involved in an issue, so if its intergenerational transactional sex, that’s an issue. There’s more than young women involved in that, there’s older men, there are wives involved or older women involved. You’re speaking Thami about the 70% happening within supposedly faithful relationships, but what are we really saying about faith? Faithfulness is really negotiable within our community and our society. As long as I don’t see it, as long as long as my partner doesn’t bring it home, then it’s fine. He’s being faithful to me, if I don’t see if it’s fine. So we’re turning a blind eye to it, and that’s why these messages are failing, because it’s not contextualised within the culture or that particular community.

Vuyani Jacobs: You see it comes with empowerment. I liked empowered women, and it’s become problematic because I come from a society of control by men, because women would tell me, ‘Either you take me, or you don’t’. Which means I’m assertive, ‘you’re going to be loyal to me, or you just get out of this relationship’, but because she’s in a power to say that, she’s in a power to act on that, it becomes an easier thing. But I think we need to give that to young girls, we need to give that pride to young girls, we need to give that pride to young boys. The same pride that gave young boys the right to have many girlfriends, the same pride we should give them to have one relationship, for instance, or to use condoms in terms of respect.

Shalom Ncala: Sozokhuluma futhi ngamaso wokhu vikhela iHIV, emva kwekefu. Siyabuya. {IsiZulu} [We talk more about HIV prevention strategies after the break.]

Shalom Ncala: [Welcome back to the Siyayinqoba Beat It! support group.] {Sesotho} Uhlelo lawonke umuntu ongenwe no thithekayo yi-HIV. Namhlanje sikhuluma kamase wokhuvikhela i-HIV futhi zingayenza njani ukuthi isebenze kakhulu. {IsiZulu} [The programme for everyone infected and affected by HIV. Today we are talking about HIV prevention strategies and how we can make them more effective.]

Busisiwe Maqungo: Now if they introduced Post Exposure Propholaxis just like the morning after pill, you sleep without a condom awuna injection entsuleni [while you are not on contraceptives,] you know you are not at risk of getting pregnant while not on contraceptives you know you are at risk of getting pregnant. The following morning, you go to the clinic and you ask the nurse, Nurse izolo ndilele ngaphadle kwe condom, ndicela undiphe i-morning after pill. [Nurse, I had unprotected sex and I need the morning-after pill.’] Then they will give you the morning after pill. But in this case, you go the following day, Nesi izolo ndilele ngaphadle kwe condom [Nurse, I had unprotected sex] and I’m afraid I might be exposed to HIV, how about Post Exposure Prophylaxis?’ bazakuxelela And then they will tell you,] ‘We can not give you Post Exposure Prophylaxis before you get tested for HIV. Now come, let us test you’. You get tested, now they find out you’re still HIV negative, or you’re HIV positive. The number grow, ikhula nantoni ngoku inumber yokutestwa kwabantu, ikhula ne responsibility. {IsiXhosa} [The number of people going to test increases, but with that comes responsibility.] Because once you get tested, you also become responsible to prevent the next person, prevent yourself from getting reinfected with the HIV, and getting the STIs.

Thami Mthembu: That’s all very well Busi, Lokhu akuqali ukuperpetuate ukuthi abantu baqale bayenze izinto ezi irresponsible? {IsiZulu} [but the first thing that comes to mind, will this not perpetuate people to be irresponsible?] I mean I’m saying this is my standard. Can one not argue ukuthi {IsiZulu} [that] it might perpetuate that behavior especially since, even now as we speak, people are always looking for a way out of using a condom.

Wayne Alexander: I just want to say, PEP is not that easy. The course is 28 days, and for anybody who’s been on ARVs, you still have the same side effects going on that, so I don’t know if it’s something you want to do every month.

Busisiwe Maqungo: It’s the same as the morning after pill. If you take the morning after pill this month, when you go to a pharmacist the next time for the morning after pill, they will ask you ‘when last did you take the morning after pill?’ Then if you tell them ‘last month’, they will tell you, ‘You have to wait for at least six months before you get another one’.

Vuyani Jacobs: The different between that pill and the post exposure is what he was saying, the first part is you get counselled, you get tested and then you get this medication so is quite are very serious thing that actually impact on behaviour.

Wayne Alexander: There’s also this new concept in prevention called ‘prevention with positives’. One of the things in the interim that we need to take us is we need to encourage people to know their status, it becomes an entry point into prevention. Once you know your status, if you’re negative, we can work with you to remain negative, but if you’re positive, we can then work with you around understanding what that means for you, but also how to prevent transmission to other people.

Shalom Ncala: Namhlanje sifunde ukuthi ukuba khona kwe HIV enuningizimu Afrika kuyangokwanda. Sindinga indlela etsha yokuvikhela i-HIV. Eningizimu Afrika kundingeka imiyalezo yethu ibhekhane nabantu abanganakekhile nabasemcephelweni wokungena yi-HIV. Kufuneka sivume ukuthi kunabantu abaningi abangeke bakhone ukhuzila icansi. Lokhu kulinganisa nabesifazane, abangakhoni ukukhulumisana ngama condom nabalingani babo, umabazoya icansini, futhi kundingeka sense abacondom atholakhale kalula.I PEP kanye ne prevention-of-mother-to-child-transmission kufanele zitholakale kalula. Akundingeki ukuthi izingane zitholakale zine HIV. Ekugcinene abantu abaningi bafuneka baye bayohlolwa for i-HIV ukuzu bangazo thelela abanye bengezazi ukuthi bane gciwane leHIV. Babukheli siyacela ukthi nisibhalele ningathinthana nathi ekumabonakude manje. Siyathemba ukuthi niwujabulele uboniso futhi niyawuzwa umoya we Siyayinqoba sisonke singayihlula. Hlanganani nathi futhi kuviki elizayo eqenjeni lethu leSiyayinqoba Beat It! Kuze kubengaleso isikathi, hlalani ninephilo futhi ninethemba, bye bye. {IsiZulu} [Today we have learnt that the SAN HIV prevalence rate keeps rising. We need a new approach to HIV prevention. In SA, we need to target our prevention messages to include ignored and vulnerable groups. We need to accept that there are many people for whom abstinence is not an option, For example, women who can’t negotiate safer sex. We also need to make condoms more widely available. PEP and PMTCT need to be more widely available. We should not have any babies testing HIV positive. And finally, many more people need to test for HIV to ensure that they do not unknowingly infect others. Viewers, please keep the letters rolling in.]

Competition: You should use a condom every time you have sex, whether you are living with HIV or not. Yes or No?

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