/ 1 July 2004

Lessons learned about Aids prevention

The Aids pandemic has taken a particularly heavy toll on Southern African countries — not least Mozambique. According to the Joint United Nations Programme on HIV/Aids (UNAids), latest statistics indicate that about 13% of the country’s 19-million-strong population is infected with HIV.

As with states elsewhere in the region, authorities and NGOs in Mozambique are giving attention to providing HIV-positive people with the anti-retroviral drugs that can prolong their lives. However, with the number of new HIV infections in the country put at about 700 a day, Aids prevention remains a matter of critical importance. Is the government rising to the challenge?

Authorities appear to admit that their efforts to date might leave something to be desired.

Diogo Milagre, deputy executive secretary of the National Council against HIV/Aids (CNCS), says that during the initial phase of the Aids pandemic, prevention programmes were directed more at providing basic information about HIV — not convincing people to change habits that might cause them to contract the virus. He also admits that the written messages used to spread the word about Aids served little purpose in a country where about 50% of the population is illiterate.

Milagre notes that certain Aids activists were themselves not fully informed about the disease, and that the prevention messages they passed on to the population might have been inaccurate.

But, he adds, any cultural change of the order that is needed to put a stop to Aids will — necessarily — be somewhat time-consuming.

”It takes time and courage to make a cool and clear analysis of what is happening, taking into account that a change of behaviour will interfere with cultural values,” he says. ”We will take some time to see the results of our job.”

Milagre also says impressions that Aids is worsening in Mozambique may simply be the result of more effective reporting about the pandemic — rather than actual increases in HIV prevalence.

Aids statistics in Mozambique are compiled from HIV tests done on pregnant women at various ”sentinel sites” in the country. There are now 40 such sites in Mozambique, up from 12 in 2000. Voluntary testing and counselling facilities for other citizens only exist in the provincial capitals and a handful of districts, however. UNAids estimates that less than 40% of the population has access to health services.

In an effort to increase the effectiveness of prevention efforts, the government has included the topic of HIV/Aids in the school curriculum this year. In addition, teachers at all levels are receiving training to enable them to address Aids-related matters during class.

Many Aids activists have highlighted the need to give women the social support and financial independence that would enable them to steer clear of relationships or professions that increase their vulnerability to HIV. Others insist that the sexual habits of men, particularly the tendency of some to have multiple sexual partners, must be altered.

Milagre says the Mozambican government does not agree that men are the biggest culprits when it comes to spreading HIV, even though many seek work in neighbouring countries, establishing second families in those states. For this reason, officials have not given attention to awareness programmes that are specifically directed at men.

The government has begun to include civil society in its Aids prevention programme — with the CNCS serving as coordinator of this initiative. The council at present receives funds from various sources, including the World Bank, some of which are given to NGOs (although a number of groups have complained of unnecessary delays in the disbursement of funds by Mozambican officials).

In a country brief issued in June last year, UNAids noted that while there were hundreds of civic groups and community-based organisations working in HIV prevention in Mozambique, many had ”weak institutional and technical capacities” that ”limited their effective involvement” in this sphere. Financial and other forms of assistance are clearly needed to make these groups a force to be reckoned with.

Amodefa is one of the civic organisations involved in Aids education, training community activists on issues of sexual health and HIV prevention. Odete Uarota, who assists with the training, says that while there have been many initiatives to halt the progress of the pandemic, most failed to deliver the desired results.

More emphasis needs to be given, she adds, to behavioural change. — IPS