WHITE PAPER

Tackling HIV in Sub-Saharan Africa with Sport- A Group EffortBy Tom Troxel

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TABLE OF CONTENTS

Background 3

Current Work 5

The Solution 8

Conclusion 12

Annotated Bibliography 13

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BACKGROUND

HIVSince the early 1980s, HIV/AIDS took the world by storm,

infecting roughly 35 million people today. This pandemic has taken the lives of nearly 36 million people.6 In 2012, 1.6 million

individuals died from AIDS, which is equivalent to 182 deaths per hour.6

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In particular, Sub-Saharan Africa has been hit especially hard due to its rampant poverty and major disparities in education and healthcare. In fact, nearly 70 percent of the world’s HIV positive population lives in Sub-Sahara.1

Doctors and scientists have not yet found a cure for this devastating illness. However, antiretroviral drugs can delay the progression of the virus and allow AIDS victims to lead relatively normal lives. Unfortunately, these drugs are quite expensive, and most Sub-Saharans cannot afford or access such medications.

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The effects of HIV/AIDS have induced tremendous economic ramifications. AIDS often kills or debilitates its victims in the prime of their youth, drastically decreasing work productivity in affected regions. In addition, education systems falter as teachers fall ill and children stay home to take care for afflicted family members. These factors result in tremendous economic adversity for many countries in Sub-Saharan Africa.

EducationEducation is central to overcoming this disease. In many

African cultures HIV/AIDS is a particularly taboo subject, and has given rise to various myths and misconceptions. Many do not understand the way in which this disease is transmitted, prevented or treated. Some believe that having sex with a virgin can cure HIV, while others assume that getting tested actually causes the infection.7 Perhaps the greatest misconception is that this disease can be transmitted simply by touching someone with HIV. As a result, infected individuals are typically ostracized from their communities, tortured by the social and physical implications of the disease. Education can dispel these harmful myths, and in turn, welcome victims back into their community.

Prevention of HIV requires basic education and relatively cheap resources. However, treating an infected person requires tremendous amounts of time and money. In their comprehensive report on HIV, the World Bank asserted that education was “the

only vaccine against HIV/AIDS we have.”3 Indeed, education appears to be the greatest weapon we have in combating this illness. Teaching individuals how to protect themselves enables

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them to make informed decisions about their health. HIV transmission can be prevented by condom usage, clean needles, and protecting the blood supply.

ChildrenOnce a child is infected with HIV he or she is infected for

life. However, once a child is properly educated in how to avoid risky behavior they can live an HIV free life 3.3 million children under the age of 15 are infected worldwide. Over 9 out of every

10 of these affected children live in Sub-Saharan Africa.1

The United Nations reported that youth aged 15-24 accounted for a staggering 42% of new infections in 2010. The World Bank found that while these youth had very high infection rates, youth aged 5-14 are basically zero HIV transmission. This age range has been termed the “window of hope”3 as it is the pivotal time to reach youth before they get the disease. But how do we target youth specifically?

SportSport is uniquely suited to be used as a tool for HIV/AIDS

education. Soccer is especially useful as it is a universal sport that is especially popular in Sub-Saharan Africa. Sport teaches youth valuable lessons such as teamwork, communication, and

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accountability. These life skills combined with HIV prevention education result in a powerful learning environment. Children who wouldn’t necessarily be incentivized to attend HIV education seminars would consistently turn up for soccer games and tournaments. The way to the hearts of the youth of Africa is through soccer.

Gilbert and Bennett, the two researchers who literally wrote the book on Sport, Peace and Development, assert that sport, through its inclusiveness, can be used to overcome discrimination and stigma by improving social integration. In addition, sport can provide role models for youth to look up to.5

Vital HIV prevention knowledge, that can change a child’s life, has a better chance of sticking with them if they learn through the medium of sport.

CURRENT WORK

In their book, Gilbert and Bennett, classify institutions involved in SDP into six categories: nation states, non-governmental organizations, inter-governmental organizations, international federations, transnational corporations, and grassroots community based organizations.5 I have simplified these groups into three main groups: governmental, non-governmental organizations (NGOs), and local community-lead grassroots organizations. All of these institutions use sports-based HIV prevention platforms in Sub-Saharan Africa. I will now examine each of these groups and their strengths and weaknesses.

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GovernmentalGovernments, through public schools, have access to

millions of students every year. Even in parts of Africa where schools are drastically underfunded thousands and thousands of children are in the classroom every day. Unfortunately, many governments in Sub-Saharan Africa are chronically impoverished and poorly managed.

In 2006, Zambia made physical education mandatory across all grade levels. According to Donald Njelesani, the government did so in order to provide for the holistic development of its youth as well as “a way to address the challenges of HIV/AIDS.”12 However, application of sports in Zambian schools faced many challenges. Senior school administrators confided in interviews that they thought physical education was a waste of time in a country where 86% of people live below the poverty line.12 As a result, the subject was often shelved in favor of other seemingly more practical lessons. In addition, interviewed teachers said “ that they had not received training from the Ministry of Education on how to incorporate HIV/AIDS within education.“12 Without any framework many teachers were not able to effectively teach these valuable lessons.

The Zambian case study showcases that without a strong centralized platform and accountability it is very hard to move a project forward on a national stage. Without guidance it would be nearly impossible for a teacher struggling with a tiny, underfunded, overfilled classroom to make their own HIV

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prevention lessons incorporating sports. But the example also provides hope for the future. What if those teachers had been given proper lesson plans and held accountable to teach them? Thousands of students could have been affected. Zambia was willing to start a program on a national level, that’s a start at least. Future programs will hopefully learn from these mistakes.

Non-Governmental OrganizationsIn the last few decades, there has been a rapid increase in

NGOs associated with sport-for-development in Sub-Saharan Africa. Many of the NGOs are run by foreign nationals and funded by the Global North. In comparison to local groups, foreign organizations often have a wealth of resources. However, their main weakness is often that they only spend a short period of time in a community and then move on. When they hold clinics and then leave, their effect on a community can be minimal.

Some groups blur the lines between these distinctions. For instance, Grassroots Soccer was originally founded as an NGO but has become, true to its name, more of a community run grassroots program as it has expanded. However, the organization claims to have reached over 600,000 individuals. A report by Zachary Kaufman in conjunction with Dartmouth Medical School examined groups of youth aged 15 to 19 who had gone through a 10 hour clinic with Grassroots Soccer and compared them to a group of students from the same communities who had not gone through any formal HIV education. Of the 14 survey questions pertaining to HIV, the Grassroots Soccer graduates only performed statistically

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significantly better in 2 areas; even then only by a small margin. Having an organization come into a community once doesn’t mean that the community has been properly educated. Grassroots Soccer might have reached 600,000 youth but the number that were actually educated long-term is unfortunately much lower. This example illustrates the fact that NGOs often have the educational tools and funding but not the long-term access to youth.

Grassroots/Local GroupsLocal programs that are started and run by community

members often have stronger trust from their people. They also have the time to better influence youth in the area. However, they infrequently have the funding, resources, or educational tools necessary to be effective in preventing HIV. But, they are very invested in the region and won’t leave to go to another region or country.

In his study of Zimbabwe, Morten Skovdal found that “community groups and networks are ‘critical enablers’ to the HIV response.”14 He found that people in Matobo, the community of study, banded together in social networks of neighbors and extended family. Those groups interacted with NGOs but their communal network was instrumental in how they acted in regards to HIV education and treatment. For instance, in the community men would not admit they had HIV, even if they knew. A fear of showing weakness cannot be merely ‘explained’ away by foreigners. Instead, a cultural shift in that community, and communities across Sub-Saharan Africa needs to occur.

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NGOs might be able to catalyze that change but at the end of the day it will take a community-based effort. Many of the interviewees in the study said that there was a “need for community groups and networks to be linked with more resourceful organizations, enabling them to more effectively respond to HIV.”14 Communities themselves are valuable resources that need to be effectively utilized in order to bring about real change in HIV education.

THE SOLUTION

Government, NGOs, and GrassrootsInstead of working separately, national governments,

NGOs and grassroots organizations should collaborate in order to combat the spread of HIV. This comprehensive approach enables these groups to combine their strengths and minimize their weaknesses. Local organizations may encourage communities to discuss HIV and its implications. As trusted members of the community, these organizations have the power to dispel social stigmas surrounding the disease. They can emphasize the importance of keeping youth in school. Governments can ensure that students receive the necessary exposure to information regarding the prevention and transmission of HIV. Finally, NGOs can maximize their resources by educating teachers and community leaders, who are in constant contact with the community at large. By holding clinics for influential adults instead of children, the NGOs’ impact can

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reach more people. These three sources offer their own distinct and necessary perspectives to afflicted communities. But how can all of these organizations work in sync?

Red CardDirect information, knowledge, and experience are

necessary for any of the above coordination to become reality. A large international organization would be necessary to bring together all of the pieces and make stopping the spread of HIV a reality. This organization, tentatively titled ‘Red Card,’ would revolutionize the way HIV prevention is performed and documented, giving HIV a metaphorical red card. This organization, styled like a Silicon Valley start-up would rely on international brand name recognition and a sleek data driven interface to become the leading authority on sport-based HIV prevention.

Currently, as showcased in this paper, there are many different fragmented groups working to prevent HIV all over Sub-Saharan Africa. However, there is no cohesive platform through which they can work together to evaluate and share methodology. By working together and utilizing the unique resources that each entity holds- Red Card could run more efficiently than each group currently operates individually.

Red Card could also serve as the figurehead organization for the Global North for donations. It is understandably hard for many people determine the validity of foreign enterprises. An ordinary person wouldn’t necessarily want to donate to an organization of uncertain trustworthiness and efficacy. By

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scaling up the current efforts, Red Card could provide a valid philanthropic option to citizens of the Global North. In addition, through achieving such scale, once the international spotlight was shined on the organization, partnerships with large multinational corporations could become a reality. It is safe to say that Red Card would be a more effective vehicle for donation than a small grassroots African organization with no marketing means.

Scientific DataVery little hard scientific data on utilizing sport for HIV

prevention education exists. I found very few sources that relied on large sample sizes, analysis of populations over time, and infection rate changes across regions. Zachary Kaufman performed a literature review of sport-based HIV prevention. He found that only “nine studies [total] have been published in peer-reviewed journals” hypothesizing that “much of the research on SBHP interventions has not been of sufficient quality to merit peer-reviewed publication.”9 Instead there are many informal surveys, interviews, and masters theses written on the subject. While these studies have their own time and place and inherently useful in their qualitative approach; empiric data is also necessary.

One of the first objectives for Red Card would be to form a standard sports-based HIV prevention curriculum and implement it widespread in several communities and do a controlled randomized study with an appropriate control group and large sample size. The number of resources available would

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limit the initial study of course. However, it would be beneficial to focus the study on a thousand individuals and use flawless methodology than to try and target a quarter of a million individuals and be less certain about the results. If the outcome of such a trial were encouraging, Red Card could use the data to leverage more funds and donations on an international stage.

A huge advantage of such an organization would be its ability to find the most efficacious practices for implementing sports-based HIV prevention education. With so many feet on the ground in different regions, using comparative statistics, the most efficient education strategies could be isolated. Once found, those methods could be easily spread to the rest of the continent. If every HIV prevention organization was using the most efficacious means to combat the disease, thousands if not millions of lives could be saved.

The next major step for Red Card would be to initially focus NGOs on teaching community leaders and teachers how to utilize sports-based HIV prevention. Many of these people in positions of influence would love to be able to teach HIV prevention but just don’t have the tools. Instead of reaching hundreds of kids, NGOs could reach thousands of youth by using existing community infrastructure. Also, in place of NGOs going into an area and holding a one-time clinic, children will hopefully be greater exposed to HIV prevention long term in their community.

Connectivity

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One of the main cornerstones of Red Card would be an online website with drills and other structured activities that adults could use to educate youth about HIV prevention. Large parts of Africa do not have Internet access; 15% of the population had internet access in 201212 and currently smartphones make up 18% of phones in Africa. However, these numbers are growing exponentially; the number of smartphones is projected to double in four years.11 In the near future, a sizable percent of Africans will have access to the Internet and therefore Red Card’s site. In the meantime, printed booklets containing all the pertinent information and distributed in the appropriate languages could be a staple for usage in feeder organizations. A Red Card app could be developed, focusing on the relative prominence of smartphones in Africa. Such an app would be equipped with all of the lesson plans necessary to run a full clinic and the information would be stored on the phone so it could be accessed without constant Internet usage.

Sports RootsNelson Mandela once said, “Sport has the power to change

the world. It has the power to inspire, it has the power to unite people in a way that little else does. It speaks to youth in a language they understand. Sport can create hope, where once there was only despair.” Red Card’s number one priority would be to stay true to its roots, using soccer to prevent the spread of HIV. Soccer is an international language. In many communities in Sub-Saharan Africa just walking onto a field with a soccer ball wins you instant friends and immediate acceptance into the

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community. This acceptance is vital in order to teach such a sensitive topic.

CONCLUSION

The HIV/AIDS epidemic is tragic. Millions of lives have been lost and millions more are in the throes of the disease. However, HIV is a completely preventable disease. By focusing on children in Sub-Saharan Africa- the most at risk demographic, and implementing an international umbrella organization using sport for education the tide could be turned. Though it may be hard for NGOs, governments, and local leaders to work together, if they are able to do so they will accomplish great feats. HIV prevention needs a new approach in order to revolutionize its progression and be updated to the 21st century of big brand names with extensive digital platforms. Red Card would allow the world to take on HIV head on.

Red Card would function as a figurehead organization in order to provide structure and support to the many groups beneath it while allowing each to adapt to the individual communities that they serve. Moreover, finding the most effective teaching methods through research and making them readily available to thousands of African communities would allow many more lives to be saved. I’m not saying it would be easy to construct such an organization. However, an organization like Red Card could pave the way to a future without HIV.

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BIBLIOGRAPHY

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1"11 Facts About HIV in Africa." Do Something. Web. 10 Mar. 2014. http://www.dosomething.org/actnow/tipsandtools/11-facts-about-hiv-africa.

2Delva, Wim, et al. "HIV prevention through sport: the case of the Mathare Youth Sport Association in Kenya." AIDS care 22.8 (2010): 1012-1020.

3“Education and HIV/AIDS- A Window of Hope.” World Bank. 9 Mar. 2014. http://siteresources.worldbank.org/EDUCATION/Resources/278200-1099079877269/547664-1099080042112/Edu_HIVAIDS_window_hope.pdf

4Fuller, Colin W., et al. "‘Football for Health’—a football-based health-promotion programme for children in South Africa: a parallel cohort study." British journal of sports medicine 44.8 (2010): 546-554.

5Gilbert, Keith, and Will Bennett. Sport, Peace, and Development. Common Ground Pub. LLC, 2012.

6HIV/AIDS Statistics: Worldwide." amfAR. Web. 9 Mar. 2014. http://www.amfar.org/about-hiv-and-aids/facts-and-stats/statistics--worldwide.

7Hu, Melody. Journ-AIDS. Web. 12 Mar. 2014. <http://www.journaids.org/index.php/blog/blog-entry/virgin_cure_myth-_alive_well/>.

8Kaufman Z, Perez K, Adams LV, Khanda M, Ndlovu M, Holmer H. Long-term behavioral impact of a soccer-themed, school-based HIV Prevention program in Zimbabwe and Botswana. In: Poster, editor. XVIII International AIDS conference, Vienna; 2010.

9Kaufman, Z. A., T. S. Spencer, and D. A. Ross. "Effectiveness of Sport-Based HIV Prevention Interventions: A Systematic Review of the Evidence." AIDS and Behavior (2013): 1-15.

10“Literature Review on the Impact of Education Levels on HIV/AIDS Prevalence Rates.” UNESCO. Web. 9 Mar. 2014. http://hivaidsclearinghouse.unesco.org/search/resources/Literature%20Review%20on%20the%20Impact%20of%20Education%20Levels%20on%20HIV-A.pdf

11Maro, C. N., G. C. Roberts, and M. Sørensen. "Using sport to promote HIV/AIDS education for at‐risk youths: an intervention

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using peer coaches in football." Scandinavian journal of medicine & science in sports 19.1 (2009): 129-141.

12Njelesani, Donald. Preventive HIV/AIDS Education through Physical Education: reflections from Zambia. Third World Quarterly. Vol. 32, No. 3, MAINSTREAMING SPORT INTO INTERNATIONAL DEVELOPMENT STUDIES (2011), pp. 435-452.

13Skovdal, Morten, et al. "Community Groups As 'Critical Enablers' Of The HIV Response In Zimbabwe." BMC Health Services Research 13.1 (2013): 1-12. Academic Search Premier. Web. 20 Feb. 2014.

14“Using Football for HIV Prevention In Africa.” Grassroots Soccer. Web. 9 Mar. 2014. <http://www.grassrootsoccer.org/wp-content/uploads/F4_HIV_Report.pdf>.

15Jidenma, Nmachi. "The real mobile revolution: Africa's smartphone future." CNN. 7 Nov. 2013. Web. 9 Mar. 2014. http://www.cnn.com/2013/11/07/opinion/real-mobile-revolution-africa-smartphone/

16Mlot, Stephanie. "Infographic: A Snapshot of Internet Use in Africa." PCMAG. Web. 13 Mar. 2014. http://www.pcmag.com/article2/0,2817,2426807,00.asp.

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