HIV/AIDS: A Cross HIV/AIDS: A Cross Cultural StudyCultural Study

Lew FrettLew FrettClaudia Kurjakovic Claudia Kurjakovic Jen McCafferty Jen McCafferty Marina SteinMarina Stein

http://youtube.com/watch?v=wrs0XBGIphM

Thesis:Thesis:

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

INDIA

India’s HIV Epidemic - Statistics In 2006, UNAIDS estimated 5.6 million living with In 2006, UNAIDS estimated 5.6 million living with

AIDS in India (highest rate in the world)AIDS in India (highest rate in the world)

In 2002, the C.I.A. predicted 20-25 million people In 2002, the C.I.A. predicted 20-25 million people would live with AIDS by 2010would live with AIDS by 2010

2007: UNAIDS Estimate: 2-3.6 million living with 2007: UNAIDS Estimate: 2-3.6 million living with HIV of 1 billion people (.41% of population) HIV of 1 billion people (.41% of population)

In 2005, a growing proportion of women (38%) In 2005, a growing proportion of women (38%) are infected with HIVare infected with HIV

Epidemic concentrated in the rural north, and Epidemic concentrated in the rural north, and mostly effects not “high risk” groups, but from mostly effects not “high risk” groups, but from heterosexual sexheterosexual sex

Indian Culture India split into 8 states with populations India split into 8 states with populations

up to 70 million each up to 70 million each

Many different languages, religions and a Many different languages, religions and a heterogeneous, diverse population heterogeneous, diverse population

HIV patients stigmatized in general HIV patients stigmatized in general population, attacked, rejected by families population, attacked, rejected by families etc.etc.

Taboo to talk about sexual practicesTaboo to talk about sexual practices

Government Reaction

National AIDS Control Program (NACP) National AIDS Control Program (NACP) launched National AIDS Control launched National AIDS Control Organization (NACO) in 1992 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 ’99-2006NACP-II ’99-2006• NACP-III launched July ’07: strong focus on NACP-III launched July ’07: strong focus on

condom promotioncondom promotion

Local Level Programs

Each state has its own AIDS Each state has its own AIDS Prevention and Control Society which Prevention and Control Society which is guided by NACO. Establishedis guided by NACO. Established• Youth campaignsYouth campaigns• Blood safety checksBlood safety checks• Use of electronic media – dramas, plays, Use of electronic media – dramas, plays,

meet with an Indian movie starmeet with an Indian movie star

NACP-III: Condom initiatives, ‘Condom NACP-III: Condom initiatives, ‘Condom Bindas Bol!’ , Kite Flying at Durga PujaBindas Bol!’ , Kite Flying at Durga Puja

Successes

HIV rates have decreased in Urban areas HIV rates have decreased in Urban areas in the South in the South

This can be attributed to: increased This can be attributed to: increased awareness from electronic and print awareness from electronic and print media, education, ability to purchase media, education, ability to purchase expensive anti-retroviral drugsexpensive anti-retroviral drugs

When state governments intervene, When state governments intervene, programs more successful (can better programs more successful (can better react to cultural practices in their region)react to cultural practices in their region)

University backed programs (UTA – University backed programs (UTA – Universities Talk Aids)Universities Talk Aids)

What hasn’t worked?

Still, the disease is stigmatizedStill, the disease is stigmatized Government officials, even medical Government officials, even medical

personnel don’t know facts of the personnel don’t know facts of the disease – discrimination against disease – discrimination against performing surgeryperforming surgery

No organization at sub-state level No organization at sub-state level (districts), no effective field (districts), no effective field organization to get programs exactly organization to get programs exactly what they needwhat they need

Recommendations

Continue education/ prevention and use of Continue education/ prevention and use of condomscondoms

Continue to tailor programs to cultural Continue to tailor programs to cultural values and different segments of the values and different segments of the population (women, workers, etc.)population (women, workers, etc.)

Increase cooperation between all levels of Increase cooperation between all levels of governmentgovernment

Mobilize field units to go into secluded Mobilize field units to go into secluded areas where rates are highestareas where rates are highest

SOUTH AFRICASOUTH AFRICA

http://www.youtube.com/watch?v=N98xMJWy9tQ

Statistics:Statistics: Life expectancy = 54 years oldLife 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 = 11% of total population (2006)(2006)

• Includes 257,000 children Includes 257,000 children (2006)(2006)

• 2015 = 6 million with AIDS 2015 = 6 million with AIDS 5.4 million deaths 5.4 million deaths 18.3% = 15-49 years old 18.3% = 15-49 years old (2006)(2006)

29.1% = pregnant women 29.1% = pregnant women (2006)(2006)

13.7% = teenage girls 13.7% = teenage girls (2006)(2006)

AIDS killed ~345,640 people = ~71% of all AIDS killed ~345,640 people = ~71% of all deaths deaths (2006)(2006)

• ~1,000 people dying from AIDS every day~1,000 people dying from AIDS every day

Cultures/Rituals:Cultures/Rituals:

The incidence of violence against The incidence of violence against women in South Africa is high andwomen in South Africa is high andcontributes to the spread of HIV contributes to the spread of HIV Ritual circumcision of adolescent Ritual circumcision of adolescent boys boys unsterilized blades unsterilized blades spread spread of HIVof HIV Adults believe in ritualized ancestralAdults believe in ritualized ancestralprotection from disease protection from disease negative negativeattitudes to condom useattitudes to condom use

• Ages 18 to 24 more positive attitudes Ages 18 to 24 more positive attitudes to AIDS precautionsto AIDS precautions

Government Reaction:

Slow provision of antiretroviral Slow provision of antiretroviral drugs influenced by attitudes that drugs influenced by attitudes that certain politicians have taken to AIDS. 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 insuggested that impact of AIDS in South Africa may have been South Africa may have been overstatedoverstated

Prevention ProgramsPrevention Programs

Focus on prevention: promoting Focus on prevention: promoting

public awareness & life skills and public awareness & life skills and

HIV/Aids education.HIV/Aids education. LoveLife and Soul City LoveLife and Soul City

High level of awareness amongHigh level of awareness among

youth – ~ 90% youth – ~ 90% Life skills & HIV/AIDS education Life skills & HIV/AIDS education

now a compulsory part of schoolnow a compulsory part of school

curriculum and fully implemented by 2003. curriculum and fully implemented by 2003.

LoveLife & Soul CityLoveLife & Soul City

• LoveLife: nationwide campaign LoveLife: nationwide campaign promoting healthy sexual behavior promoting healthy sexual behavior among adolescents, reduce incidence of among adolescents, reduce incidence of HIV/Aids, STDs, & teen pregnancies. HIV/Aids, STDs, & teen pregnancies.

Widespread media campaign & educational, Widespread media campaign & educational, recreational & sexual health services.recreational & sexual health services.

• Soul City: mass media to promote Soul City: mass media to promote awareness around health issues. awareness around health issues. Integrates education and entertainmentIntegrates education and entertainment

Prevention Programs Cont.Prevention Programs Cont.

Preventing mother-to-child Preventing mother-to-child transmissiontransmission• 18 research sites; 38,000+ mothers18 research sites; 38,000+ mothers• Offers HIV testing, antiretroviral, Offers HIV testing, antiretroviral,

vitamins, treatment for infection, vitamins, treatment for infection, formula – started in 2003 formula – started in 2003

RecommendationsRecommendations

2007 2007 National Strategic HIV/AIDS plan to National Strategic HIV/AIDS plan to guide SANAC from 2007 to 2011guide SANAC from 2007 to 2011 • stronger stance on treatment provision stronger stance on treatment provision • Emphasizes Emphasizes co-operation between the co-operation between the

government and civil society groups. government and civil society groups.

Continue awareness campaigns & Continue awareness campaigns & educationeducation

Continue antiretroviral supply & treatmentContinue antiretroviral supply & treatment

Success StoriesSuccess Stories

THAILANDTHAILAND First case diagnosed in First case diagnosed in

19841984 Early responses by the Early responses by the

government targeted only government targeted only “high risk” groups“high risk” groups

Thailand’s government Thailand’s government realized that with economy realized that with economy would suffer if they did not would suffer if they did not deal with HIV/AIDS deal with HIV/AIDS properlyproperly

Mechai Viravaidya the Mechai Viravaidya the Founder and Board Founder and Board Chairman of The Population Chairman of The Population & Community Development & Community Development AssociationAssociation

Letters to Loved Ones: Letters to Loved Ones: Please Don’t Bring HIV Please Don’t Bring HIV HomeHome

UGANDAUGANDA First case diagnosed in First case diagnosed in

19821982 Government response in Government response in

1986 after the President 1986 after the President took an interest in the took an interest in the disease after his son died disease after his son died of AIDS.of AIDS.

The first program included The first program included providing safe blood providing safe blood products and education products and education about the risks of about the risks of HIV/AIDS.HIV/AIDS.

President advised people President advised people to abstain from sex before to abstain from sex before marriage and remain marriage and remain faithful to their partners, faithful to their partners, but most importantly he but most importantly he advocated the use of advocated the use of condoms. condoms.

CONCLUSIONCONCLUSIONRecommendationsRecommendations

http://youtube.com/watch?http://youtube.com/watch?v=2HPNuuB9Qngv=2HPNuuB9Qng

Continue use of pro-condom programs and Continue use of pro-condom programs and education – make available to all.education – make available to all.

Tailor each program to region – take into Tailor each program to region – take into account cultural practices.account cultural practices.

We do not advocate abstinence only We do not advocate abstinence only programs.programs.

Allocate resources more effectively.Allocate resources more effectively. Cooperation among governments & civil Cooperation among governments & civil

society groups transnationally.society groups transnationally.

BibliographyBibliography

http://www.southafrica.info/http://www.southafrica.info/ http://www.avert.orghttp://www.avert.org http://www.Unaids.orghttp://www.Unaids.org http://www.Indianembassy.orghttp://www.Indianembassy.org http://www.Worldbank.orghttp://www.Worldbank.org http://www.Sciencemag.orghttp://www.Sciencemag.org http://www.Globalhealth.orghttp://www.Globalhealth.org