Tuesday, June 23, 2009

The Hot Air of Publicity

I'm always pleased when I come across articles suggesting that too little money is being spent on HIV treatment and care and not enough is being spent on prevention. I'll be even more pleased when prevention campaigns try to expand on and explain exactly what they mean by words that have strong religious connotations, such as 'fidelity', 'faithfulness' and 'abstinence'. We probably can't do without such words but prevention campaigns need to address the circumstances in which people live, especially the circumstances that determine when, where, with whom and how often they have sex.

Slick advertising campaigns are all very well for pumping out slogans that the media can repeat endlessly but the messages, ultimately, need to make sense to people. It needs to be possible for them to protect themselves from dangers like sexually transmitted infections, unplanned pregnancies and HIV. After all, if a certain sort of behaviour is 'immoral' it needs to be possible for people to avoid it and if a certain sort of behaviour is 'moral' it needs to be possible for people to behave in that way.

For example, if having sex with someone to whom you are not married or having sex with many different people are examples of immoral behaviour, it needs to be possible for people to avoid engaging in these activities. But many people, sometimes referred to as 'commercial sex workers', are often just people who have been left with no other option when it comes to providing for themselves and their families. They need to be pragmatic because the people who are wagging the moral finger at them are certainly not offering them an alternative.

Similarly, fidelity and faithfulness are great for people who are in a certain sort of relationship, for example, marriage or any long term partnership. But both (or all) parties in a relationship need to observe the principle. Where one or both parties have other, concurrent sexual partners, there is little point in recommending 'abstinence' until marriage. If one partner chooses to 'abstain' until marriage, the other partner may not choose to. Then, even the partner who abstains could still become infected with HIV.

And plenty of research has shown that, despite lengthy HIV prevention campaigns in most countries in the world, a lot of people do not only have one partner in their lifetime, a lot of people don't only have one partner at a time and a lot of people don't see being in a long term relationship or being married as a reason not to have sex with someone else every now and again, or even frequently.

HIV prevention campaigns can continue to do what they have been doing for over two decades, lecturing people about what they should and shouldn't do, or they can look at some realities. Firstly, some people don't always do what they 'should' do and some often do what they 'shouldn't' do. Secondly, others are not always in a position to do what is considered moral or avoid what is considered immoral. These campaigns may have some kind of moral high ground but they do not have much relevance to the way people lead their lives.

Even campaigns that advocate for the use of condoms need to ensure that people are enabled to use condoms. If you are depending on sex for your income, using a condom may protect you; but agreeing to sex without a condom will pay better, often far better. If you are married or in a stable or long term relationship you may find it difficult to get your partner to use a condom. Apparently, many refuse to use a condom with their spouse or long term partner.

Slogans, wristbands and media campaigns may (or may not) have done great things in the past but they will never be enough on their own. If people are forced to have sex for money, there is a serious economic problem. If people are not able to choose to use a condom there could be a legal problem and perhaps an issue of gender inequality that needs to be addressed. There are people, usually women, who are required to sleep with their boss to get a job, keep a job, get promotion or even to get paid. This suggests serious corruption and lack of protection for people who may be particularly vulnerable.

Unless these prevention campaigns address these and other circumstances in which people live, they might as well not bother. Young girls are being encouraged or even forced to have relationships or even to marry older men, sometimes their teachers, in order to get some financial support, school fees or some other benefit. There is no point in telling them that what they are doing is wrong or in telling them about the virtues of abstinence, fidelity, condom use, virginity or any other platitude.

Campaigns in the past in Uganda, Senegal and even Kenya, have been called 'successful' but as long as people are prevented from protecting themselves, HIV and other sexually transmitted diseases will continue to spread. There may continue to be fluctuations but for real, long term success, people need to be able to avoid risky situations, they need to be self reliant, they need to be far more autonomous than they are now. The economic, health, educational, legal, employment and other conditions facing people in Kenya and other developing countries need to change drastically. The hot air of publicity will never achieve anything on its own.


No comments: