This Saturday, I attended the workshop on AIDS in Africa that was lead by Lisa Adams, who is an assistant professor at Dartmouth College, and coordinator of Dartmouth’s Global Health Initiative.

As a group of about 10, we discussed how to spread knowledge and information about HIV/AIDS to younger generations and address problems facing health-care providers in Africa.

-Lisa introduced herself and gave us a brief background of the progress of AIDS relief in Africa. Because of the work of programs  initiated during the Clinton and Bush administration (i.e, PEPFAR, CHAI), most areas of Africa have access to necessary drugs and care. The problem has become more of a social one, and the focus has now moved to the prevention of AIDS as well as the treatment.

-Lisa emphasized the importance of teaching youth AIDS prevention and awareness. WHAT AGE, she asks, should this education begin? As a group we discussed…

• starting when kids leave for home for a boarding school (very common in Africa)- around age 12.  (free from parental disapproval, with peers)
• maybe starting at an even younger age, because so many have been exposed to the disease with deaths in their areas.
• When do we first learn of AIDS? Around 6th grade for most American schools.
• We finally decided that the age range of 12-19 seemed best.

Then she asked us to discuss WHO should be involved in teaching kids? As a group we came up with the following list..

• via School teachers, have AIDS education incorporated into the standard curriculum (especially at the boarding schools). We thought it would be especially important that this be part of the regular school day and not an afterschool activity
• community health workers going to schools
• parents (if they support it)
• community/ religious leaders (depends on religion and community values)
• peers/friends (we discussed the possibility of training older kids to be peer educators for younger grades. Peers are probably more effective than parents in transmitting information)
• siblings
• health care workers (ex. when visiting the doctor)
• coaches (we talked about this program called Grassroot Soccer, which mixes soccer training and concepts with HIV/AIDS education)
• media- pampthlets, billboards (very succesful strategy in Ghana- see pics)
• HIV+ person

We spent most of our time talking about the power of both peers and mentors. At a certain point, kids stop listening to their parents, and for many of them, something that a peer (especially an older one) or a coach says is much more respected. We also mentioned the importance of having someone confidential to talk to, and whether the person teaching the kids should be taught by someone close to them (a sibling, parent) or a stranger, but from the community (older peer), or a complete stranger (health workers).  One girl, who had actually seen an AIDS information session given to kids in Jamaica, said that the kids were not as willing to listen to a stranger.

Content of the AIDS/HIV awareness education

We all agreed that it had be a uniform message, given without bias or judgement, and that, in most cases, some sort of training should be required. (Who provides training? We didn’t discuss that…). Lisa talked about the ABC’s, Abstinence, Be faithful, and Condoms. When PEPFAR was initiated, a certain percentage of the funds had to go towards Abstinence information. One girl, who had traveled to Russia and worked with prostitutes, STD’s, and drug use there, said that a large part of PEPFAR proved to be a waste of money in the area she was in because of this stipulation (it wasn’t that effective to lecture sex workers on being abstinent). We discussed putting more focus on teaching abstinence as a way to delay having sex, rather than 100% avoiding it. We also thought that the ABC’s method should be modified depending on who the audience is (when talking to older teens, put more emphasis on prevention techniques than “Being Faithful” which is more appropriate for married couples).

Factors affecting HIV/AIDS education and prevention

• Religion- some prohibit the use of birth control
• Culture- often taboo to discuss sex and AIDS in areas of Africa, especially to children
• Stigma- people with HIV face prejudice (we discussed how an HIV+ person would be treated on Middlebury campus)
• Opportunity Costs- even though treatment is free in most areas, costs of transportation, lab tests, etc. sometimes make treatment impossible

Disclosing Status: At what age do you tell HIV+ kids (who had it passed on through their mother’s  of their status? In general, we thought the younger the kid, the better. Then they could have more time to accept their situation and learn about the consequences of spreading the disease. But, in many areas of Africa, parents do not tell their children until pretty late. Many kids take treatment drugs, but are never told what they are taking them for. Parents are often racked with guilt and fear about telling the child, and they put it off until the kid is already sexual active or thinking seriously about it. This is one of the biggest problems facing health care officials. Do they have the authority to inform kids without full parental consent? How do they convince parents/relatives of the importance of informing the kid as soon as possible? In the ideal situation, we thought it would be best if the medical worker talks with the parent privately (in an effort to convince them that sooner is better) and then both the parent and health care worker, together, inform the child. Still, this is a very messy issue in Africa, and one that is causing considerable tension between health care workers and parents/members of the communities.  Uninformed HIV+ kids are becoming a large part of the continuing spread of the disease.

Lisa wrapped up by reminding us of the multifaceted and complex issue that is AIDS/HIV awareness and prevention in Africa. She reminded us, too, that many of the issues are no longer medical ones, but cultural ones. These, she said, are the hardest to fix.

Zoe