I am responsible to prevent HIV
Occasional Kubatana blogger Fungai Machirori recently posted a very interesting comment on a health listserv in response to an online conversation about who should take responsibility for HIV prevention. I kind of thought it was a no-brainer. Individuals should of course. But then again there are men involved and condoms and men in general go together like Mugabe and Democracy.
Here’s Fungai for you:
Ensuring power to every “i” Fungai Machirori
Last year, South Africa developed a remarkable graphic to accompany its World AIDS Day campaign message: a graphic consisting entirely of a myriad letter “i”s that together made up the shape of South Africa’s map.
The tagline that accompanied the graphic read “I am responsible. We are responsible. South Africa is taking responsibility.”
What each of those little “i”s stood for was a South African; an individual taking responsibility for adopting health-promoting behaviours that would ultimately yield the collective national responsibility needed for an effective response to the urgency of HIV and AIDS.
I give this example because I feel it is particularly relevant to the topic at hand – whose responsibility it is to prevent HIV.
I believe that only once every individual is able to identify himself or herself as that “i” with the highest levels of self-efficacy, or confidence in one’s own ability to take responsible action, can we realise a significant change to the emergency that is the HIV and AIDS pandemic.
Building that self-efficacy encompasses creating a range of competences, from the basic ability to understand what HIV and AIDS are, to comprehending the implications of HIV infection or re-infection, as well as the benefits of preventing such infection, all the way to being able to overcome the many barriers that may exist as impediments to positive behaviour change.
Make no mistake, this is no easy process. Because we are all individuals of differing backgrounds and circumstances, our competencies, and the rates at which these can be developed will differ.
What levels of self-efficacy will a 16-year-old girl given to her sister’s widow as a replacement wife (knowing well that her sister died of a long and mysterious illness) have to demand an HIV test even if she knows about the virus and its effects, but is bound, by family tradition, to become this man’s wife without questioning?
What self-efficacy can a baby, still in his mother’s womb, speak of if his mother never receives antenatal services and does not discover her own positive HIV status until after her baby is born and already infected?
How then do we ensure power to every “i”?
A blanket approach to HIV and AIDS programming is definitely not the right way. Insensitive messaging that fails to take into consideration that we are all at different levels of literacy, understanding and openness about the collective and individual impact of the pandemic is more detrimental than helpful as it only achieves the churning out of impersonal, and therefore, inaccessible content.
Some people still just need to hear the basics – what HIV is, how it brings on AIDS, how it is transmitted and how it is prevented.
And messages and programmes for these individuals need to be tailored in an attractive, interactive fashion that eliminates pedagogy by welcoming debate, discussion and personal negotiation.
Also, we need to stop thinking only in conventional formats because quite honestly, far too many of the information-rich booklets and CD-ROMs dished out generously by well-meaning organisations are NOT being read or utilised.
I remember looking on in horror as a neighbour used the pages of an HIV prevention book I had given him to get a fire going in his backyard.
Noticing my anguish, he apologised but told me that there was no other practical use for the book beyond the one he had found.
“Thankfully, I have toilet paper,” he joked.
I went away wondering how many other people might feel this way about Information and Education Communication (IEC) materials that they feel have no resonance with them.
We need to be doing things differently, dynamically and determinedly all the time within an environment that is constantly changing, but at the same time staying very much the same.
Also, we need to think creatively about how to overcome the many socio-cultural and economic barriers to information dissemination and knowledge assimilation; how to jump over those internal walls that cement ideas within people’s minds that saying “not yet” or demanding a condom during sex is taboo and unforgivable; how to ensure that we are catering to communities and societies and individuals at their points of need, and not at the points that we estimate on their behalf; how to be relevant.
In short, how do we ensure that when an individual makes a decision that can have an impact on the state of their health, he or she is fully equipped with the artillery of internalised practical and practicable information?
At the same time as we seek to answer this question, we must focus attention on the dire need to strengthen our HIV service delivery systems to the point where people can access the different prevention, treatment, care and support packages that they require in an efficient, effective and professional(in terms of the health service providers) manner.
Our role as programmers, advocates, researchers and role models is two-fold: firstly, we must take personal responsibility for our own behaviours ensuring that they are positive and health-promoting.
Too many jokes abound about how any workshop that involves HIV programmers and advocates degenerates, after hours, into a ‘sex shop’.
This is the unfortunate badge of embarrassment that many associate our sector with, particularly as it identifies us as obvious hypocrites who subscribe to the mantra, “Do as I say, not as I do.”
Only once we are right in our own ways can we strike a cord with our audiences so that we may pass the mantle of responsibility on to them, to capacitate them to answer emphatically, whenever asked whose responsibility it is to prevent HIV, that indeed it is “i”.
Imagine if we could draw out a map, not just of South Africa, but of every nation in our region from the pledge made by every “i”, every person putting their hand up to say, “I am responsible to prevent HIV”.
This map would certainly mark the beginnings of a new Africa.