HIV/AIDS: A Cross Cultural Study Lew Frett Claudia Kurjakovic Jen McCafferty Marina Stein

Thesis: Through our study of HIV/AIDS in India, South Africa, Thailand and Uganda it is clear that condom programs as a means of preventing HIV/AIDS transmission achieve great success rates and thus, should be used more frequently. Also, there needs to be an increase in the usage of education programs that will target the entire population.

INDIA

India’s HIV Epidemic - Statistics In 2006, UNAIDS estimated 5.6 million living with AIDS in India (highest rate in the world) In 2006, UNAIDS estimated 5.6 million living with AIDS in India (highest rate in the world) In 2002, the C.I.A. predicted million people would live with AIDS by 2010 In 2002, the C.I.A. predicted million people would live with AIDS by : UNAIDS Estimate: million living with HIV of 1 billion people (.41% of population) 2007: UNAIDS Estimate: million living with HIV of 1 billion people (.41% of population) In 2005, a growing proportion of women (38%) are infected with HIV In 2005, a growing proportion of women (38%) are infected with HIV Epidemic concentrated in the rural north, and mostly effects not “high risk” groups, but from heterosexual sex Epidemic concentrated in the rural north, and mostly effects not “high risk” groups, but from heterosexual sex

Indian Culture India split into 8 states with populations up to 70 million each India split into 8 states with populations up to 70 million each Many different languages, religions and a heterogeneous, diverse population Many different languages, religions and a heterogeneous, diverse population HIV patients stigmatized in general population, attacked, rejected by families etc. HIV patients stigmatized in general population, attacked, rejected by families etc. Taboo to talk about sexual practices Taboo to talk about sexual practices

Government Reaction National AIDS Control Program (NACP) launched National AIDS Control Organization (NACO) in 1992 National AIDS Control Program (NACP) launched National AIDS Control Organization (NACO) in 1992 Three Phases of NACP: Three Phases of NACP: NACP-I lasts from 1992-’99;NACP-I lasts from 1992-’99; NACP-II ’ NACP-II ’ NACP-III launched July ’07: strong focus on condom promotionNACP-III launched July ’07: strong focus on condom promotion

Local Level Programs Each state has its own AIDS Prevention and Control Society which is guided by NACO. Established Each state has its own AIDS Prevention and Control Society which is guided by NACO. Established Youth campaignsYouth campaigns Blood safety checksBlood safety checks Use of electronic media – dramas, plays, meet with an Indian movie starUse of electronic media – dramas, plays, meet with an Indian movie star NACP-III: Condom initiatives, ‘Condom Bindas Bol!’, Kite Flying at Durga Puja

Successes HIV rates have decreased in Urban areas in the South HIV rates have decreased in Urban areas in the South This can be attributed to: increased awareness from electronic and print media, education, ability to purchase expensive anti-retroviral drugs This can be attributed to: increased awareness from electronic and print media, education, ability to purchase expensive anti-retroviral drugs When state governments intervene, programs more successful (can better react to cultural practices in their region) When state governments intervene, programs more successful (can better react to cultural practices in their region) University backed programs (UTA – Universities Talk Aids) University backed programs (UTA – Universities Talk Aids)

What hasn’t worked? Still, the disease is stigmatized Still, the disease is stigmatized Government officials, even medical personnel don’t know facts of the disease – discrimination against performing surgery Government officials, even medical personnel don’t know facts of the disease – discrimination against performing surgery No organization at sub-state level (districts), no effective field organization to get programs exactly what they need No organization at sub-state level (districts), no effective field organization to get programs exactly what they need

Recommendations Continue education/ prevention and use of condoms Continue education/ prevention and use of condoms Continue to tailor programs to cultural values and different segments of the population (women, workers, etc.) Continue to tailor programs to cultural values and different segments of the population (women, workers, etc.) Increase cooperation between all levels of government Increase cooperation between all levels of government Mobilize field units to go into secluded areas where rates are highest Mobilize field units to go into secluded areas where rates are highest

SOUTH AFRICA

Statistics: Life expectancy = 54 years old Life expectancy = 54 years old Without AIDS = 64+ years oldWithout AIDS = 64+ years old 5.4 million people living with AIDS 5.4 million people living with AIDS = 11% of total population (2006) = 11% of total population (2006) Includes 257,000 children (2006)Includes 257,000 children (2006) 2015 = 6 million with AIDS  5.4 million deaths2015 = 6 million with AIDS  5.4 million deaths 18.3% = years old (2006) 18.3% = years old (2006) 29.1% = pregnant women (2006) 29.1% = pregnant women (2006) 13.7% = teenage girls (2006) 13.7% = teenage girls (2006) AIDS killed ~345,640 people = ~71% of all deaths (2006) AIDS killed ~345,640 people = ~71% of all deaths (2006) ~1,000 people dying from AIDS every day~1,000 people dying from AIDS every day

Cultures/Rituals: The incidence of violence against The incidence of violence against women in South Africa is high and contributes to the spread of HIV Ritual circumcision of adolescent Ritual circumcision of adolescent boys  unsterilized blades  spread of HIV Adults believe in ritualized ancestral Adults believe in ritualized ancestral protection from disease  negative attitudes to condom use Ages 18 to 24 more positive attitudesAges 18 to 24 more positive attitudes to AIDS precautions

Government Reaction: Slow provision of antiretroviral Slow provision of antiretroviral drugs influenced by attitudes that certain politicians have taken to AIDS. President Mbeki: HIV not cause of AIDSPresident Mbeki: HIV not cause of AIDS  largely avoided issue of what  largely avoided issue of what causes AIDS, but has repeatedly causes AIDS, but has repeatedly suggested that impact of AIDS in suggested that impact of AIDS in South Africa may have been South Africa may have been overstated overstated

Prevention Programs Focus on prevention: promoting public awareness & life skills and HIV/Aids education.  LoveLife and Soul City High level of awareness among youth – ~ 90% Life skills & HIV/AIDS education now a compulsory part of school curriculum and fully implemented by 2003.

LoveLife & Soul City LoveLife: nationwide campaign promoting healthy sexual behavior among adolescents, reduce incidence of HIV/Aids, STDs, & teen pregnancies.LoveLife: nationwide campaign promoting healthy sexual behavior among adolescents, reduce incidence of HIV/Aids, STDs, & teen pregnancies. Widespread media campaign & educational, recreational & sexual health services. Widespread media campaign & educational, recreational & sexual health services. Soul City: mass media to promote awareness around health issues. Integrates education and entertainmentSoul City: mass media to promote awareness around health issues. Integrates education and entertainment

Prevention Programs Cont. Preventing mother-to-child transmission Preventing mother-to-child transmission 18 research sites; 38,000+ mothers18 research sites; 38,000+ mothers Offers HIV testing, antiretroviral, vitamins, treatment for infection, formula – started in 2003Offers HIV testing, antiretroviral, vitamins, treatment for infection, formula – started in 2003

Recommendations 2007 National Strategic HIV/AIDS plan to guide SANAC from 2007 to National Strategic HIV/AIDS plan to guide SANAC from 2007 to 2011 stronger stance on treatment provisionstronger stance on treatment provision Emphasizes co-operation between the government and civil society groups.Emphasizes co-operation between the government and civil society groups. Continue awareness campaigns & education Continue awareness campaigns & education Continue antiretroviral supply & treatment Continue antiretroviral supply & treatment

Success Stories Success Stories THAILAND First case diagnosed in 1984 First case diagnosed in 1984 Early responses by the government targeted only “high risk” groups Early responses by the government targeted only “high risk” groups Thailand’s government realized that with economy would suffer if they did not deal with HIV/AIDS properly Thailand’s government realized that with economy would suffer if they did not deal with HIV/AIDS properly Mechai Viravaidya the Founder and Board Chairman of The Population & Community Development Association Mechai Viravaidya the Founder and Board Chairman of The Population & Community Development Association Letters to Loved Ones: Please Don’t Bring HIV Home Letters to Loved Ones: Please Don’t Bring HIV HomeUGANDA First case diagnosed in 1982 First case diagnosed in 1982 Government response in 1986 after the President took an interest in the disease after his son died of AIDS. Government response in 1986 after the President took an interest in the disease after his son died of AIDS. The first program included providing safe blood products and education about the risks of HIV/AIDS. The first program included providing safe blood products and education about the risks of HIV/AIDS. President advised people to abstain from sex before marriage and remain faithful to their partners, but most importantly he advocated the use of condoms. President advised people to abstain from sex before marriage and remain faithful to their partners, but most importantly he advocated the use of condoms.

CONCLUSION Recommendations ng ng ng ng Continue use of pro-condom programs and education – make available to all. Continue use of pro-condom programs and education – make available to all. Tailor each program to region – take into account cultural practices. Tailor each program to region – take into account cultural practices. We do not advocate abstinence only programs. We do not advocate abstinence only programs. Allocate resources more effectively. Allocate resources more effectively. Cooperation among governments & civil society groups transnationally. Cooperation among governments & civil society groups transnationally.

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