A different approach to HIV/AIDS… South Africa confronts disease head-on

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Another World AIDS has come and gone, and the statistics, especially for the Black community, remain grim.

According to the latest info available from the U.S. Dept. of Health and Human Services’ Office of Minority Health, racial and ethnic minorities accounted for almost 68 percent of the newly diagnosed cases of HIV and AIDS in 2007. In 2007, 88 percent of babies born with HIV/AIDS belong to minority groups.

THEATRE—Members of Education Theatre Co., from left: Back row: Burt Davis (manager), Michelle Pietersen and Ralston Oliphant and front: Christy-Ann Julies, Hilton Andries, Vicky Davis (playwright), Percy Speelman, Olivia Adams and Prof Jimmie Earl Perry.
EDUCATION THEATRE— Members of Education Theatre Co., from left: Back row: Burt Davis (manager), Michelle Pietersen and Ralston Oliphant and front: Christy-Ann Julies, Hilton Andries, Vicky Davis (playwright), Percy Speelman, Olivia Adams and Prof Jimmie Earl Perry.

In the African-American community, HIV/AIDS continues to be an epidemic. African-Americans accounted for 49 percent of all HIV/AIDS cases diagnosed in 2007. African-American men are more than nine times more likely to die of AIDS than non-Hispanic White men. AIDS is the third leading cause of death in African-American women aged 35-44 and the third leading cause of death in African-American men, aged 35-44, in 2006.

Although African-Americans are only 13 percent of the U.S. population, they account for 49 percent of HIV/AIDS cases in 2007.

African-American males had over seven times the AIDS rate as White males.

African-American females had over 22 times the AIDS rate as White females.

African-American men were over nine times as likely to die from HIV/AIDS as non-Hispanic White men.

African-American women were over 20 times as likely to die from HIV/AIDS as non-Hispanic White women.

More troubling than the statistics is that for the most part, the African-American community continues a function in a state of denial. The statistic indicates continued risky behavior that adds to an already troubling number of disproportionate cases of HIV/AIDS affecting the Black family, friends and neighbors. And this does not have to be the case. The South African governments and several institutions have come to the forefront to contain the pandemic.

TEEN-RADIO
TEEN RADIO—A teen prepares his local radio show at a youth center in Mandeni, a rural area about 30 miles from Durban, South Africa. LOVELife, an organization dedicated to helping South Africa youths become informed about HIV/AIDS, funded the center.

Until 1998 South Africa had one of the fastest expanding HIV/AIDS epidemics in the world, but HIV prevalence now appears to have stabilized, and may even be declining slightly. For example, among teenage girls, the rate fell from 16.1 percent in 2004 to 12.9 percent in 2007, possibly indicating a drop in the rate of new infections. The South African Department of Health believes this is due to a change in safer sexual practices among younger women. The inability to moderate cultural circumstances is believed to be a factor in the high and rising HIV prevalence among relatively older women.

Based on the 2008 South African National HIV Survey, the researchers estimate that 10.9 percent of all South Africans over two years old were living with HIV in 2008. In 2002 and 2005, this figure was 11.4 percent and 10.8 percent, respectively, showing a degree of stabilization. Among those between 15 and 49 years old, the estimated HIV prevalence was 16.9 percent in 2008. The survey found the prevalence among children aged 2-14 to be 2.5 percent, down significantly since 2002, when prevalence was 5.6 percent.

The changes in the South African numbers can be attributed to how the community has responded.

“It’s astonishing to see the rate at which Africa, especially South Africa begin to deal with the problems,” said Ervin Dyer, a former newspaper reporter who began covering the crisis of HIV in Africa more than 10 years ago.

Shortly after Nelson Mandela completed his term as South Africa’s first democratically elected president, Dyer made one of his first visits to Durban. It was 2000, and he went to local villages to celebrate the launching of World AIDS Day. In one village, it was solemn because it was more memoriam than celebration.

“What we learned,” Dyer said, “ was that there was shame, stigma attached to HIV that people, especially women, were being stoned to death for publicly admitting they were HIV positive. I went to the gravesite of Gugu Dalamini, a woman infected by her husband. She came forth and villagers stoned her to death.”

Dyer also recalls Mandela was so harried trying to keep a newly freed South Africa from melting down that he didn’t give much attention to the HIV crisis. His successor, Thabo Mbeki, spoke out publicly that HIV was not a problem and refused to build a campaign of education and health to keep people safe. As a result, South African became know as ground zero in the crisis. More people were infected with HIV in South Africa than any other place in the world.

With such a crisis, South Africa could not ignore HIV. The nation had one of the most aggressive and successful campaigns, LOVELife, that was targeted toward youth education. It used mass media, bold language and grass roots leaders to help people understand and deal with the severity of the problem.

“Poverty and lack of access to health and services can exacerbate the problems and myths of cures and male domination in intimate relations are still factors in spreading the virus,” said Dyer, “but at least people aren’t being stoned to death.”

Today, there are churches in South Africa that advocate condom usages and have conduct community health and outreach campaigns. “There is a long way to go,” said Dyer, who recently returned from trip to Cape Town, South Africa, where he discussed the issues with community and township leaders.

It is in stark contrast to response in Black churches in the U.S. Minister Marvin Miller of Nazarene Baptist Church in Homewood was also in Cape Town and offered some hard truths differences on both sides of the Atlantic.

“[Here] pastors tend to be concerned about their ‘house’—meaning the church which they pastor, total membership and entertainment—than in addressing the specific needs of the community,” said Miller.

“We have fallen short of our evangelical mission. We have neglected the hurts and pains that the community suffers. We do not talk about HIV/AIDS prevention and/or testing, or even sex, because we fear hurting the sensibilities of a few. As a result, there is a disconnect between the messages that are preached and the real concerns among the people.”

Miller attended a Sunday service at JL Zwane Church in Gugulethu, a lower middle class township just outside of Cape Town.

“The South African churches are determined to tell the stories; preaching hope, faith and salvation to the people about risky behavior. Indeed, HIV/AIDS ministries are boldly proclaimed during the worship service. This has encouraged the people to minister and care for those who are infected and affected by HIV/AIDS,” Miller reflected. “The South African churches have responded to and with the community and together this collaboration has helped to stabilize the spread of HIV/AIDS.”

Lisa Kay Davis, a graduate student at Carnegie Mellon, attended the same service with Miller and she, too, was struck by the differences, which she shared in her blog.

“On certain level, it is similar to churches at home, but without the excess. No color programs. No expensive audiovisual setup. No elaborate music ministry with over the top solos. Worship and community is the focus. We are given a hymnal and invited to sit. I study the podium and wait for service to begin. The podium is draped with a banner with an AIDS ribbon that states, “JL Zwane Cares”—a clear statement about the role of the church and the AIDS crisis here. In fact, at this church, a congregant loses a relative to AIDS weekly. Keep in mind that the congregation is much smaller than many American churches and the loss is much more significant in terms of number.

“A women stop steps forward to give her testimony in a mix of Xhosa and English. She tells her community about her commitment to HIV testing every three months, how there is no shame and she is proud to share. The pastor joins in, ‘How often do you go? Every three months, you say?’ I sit and think, this would never happen at home. No one is squirming in their chairs, no one has left and there will be no nasty e-mails to the pastor afterward. Without question, this is one of the most cohesive church congregations that I have seen—ever. It is understood that these messages save lives and possibly a country.”

Davis’ blog continues: “After testimonials, we are eased into a beautiful, meditative prayer. We simply sing ‘Glory Hallelujah.’ It is simple praise, but it holds a restorative power. The pastor delivers a sermon about the greatness of God and His promise. He tells the audience, ‘The reason we talk about AIDS/HIV in church is that we expect our leaders to carry the message to the community.’ He encourages his church to move forward with purpose, ‘Let us look at yesterday to inform us on how to walk today.’”

This is where the Africa Institute for HIV/AIDS Management comes into play. Originally part of the Department of Industrial Psychology at Stellenbosch University, the center, established in January 2003, is now a separate unit for education, research and community service related to HIV and AIDS management in the workplace. It offers the most comprehensive HIV training programs in the world, empowering people to take control of the epidemic and to reach out to those affected by HIV and AIDS.

Situated approximately 30 miles northeast of Cape Town, the Africa Institute first presented in 2001 a post-graduate diploma in HIV/AIDS management (PDM). Today the center also presents a master’s program with students from more than 18 countries.

The Africa Institute for HIV/AIDS Management uses interactive educational theater to address the mobilization of communities with respect to HIV and AIDS. This includes eliminating stigma, developing partnerships between social and governmental decision-makers and systematically involving infected and affected communities and individuals.

The Educational Theatre Company, established in 2004, fulfills this role. Actors, mostly from the Stellenbosch community, were auditioned and selected and trained in dramatic performance, theater skills as well as HIV and AIDS awareness.

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