the Post Online, 6 July 2014

"New HIV infections can be stopped only by individuals changing their sexual behaviour." Prof (Fr) Michael J Kelly, Society of Jesus

RECENTLY, I have been made aware that as much as we have made tremendous progress in disseminating information about HIV and AIDS, we still have a lot of work to do at the individual and personal levels. There are many individual people for whom all the information and knowledge they have received and continue to receive about HIV and AIDS, the less they feel inclined to take the first step to get an HIV test done. There are still people who are not able, ready or willing to undergo HIV testing.

For people working in HIV and AIDS issues, especially those who have themselves taken the step and been tested once or several times, it is sometimes difficult to understand how anyone could be afraid to find out if they have been infected with HIV. For any Zambian between the ages of 15 and 49 years, there is over 80 per cent chance that they will be HIV negative. Statistics from the last Zambia Demographic Health Survey (ZDHS 2007), that on average about 14 per cent of us are infected, which means that about 80 per cent do not have HIV. Still it is difficult to convince those who are plain afraid and, or unwilling to undergo testing.

Last Thursday, as I spoke with over a hundred employees of Chililabombwe Municipal Council in Lubengele Hall, one young lady said that she was strongly opposed to me asking people in the audience to feel free to go and cue up for VCT, just outside the hall where a VCT tent had been set up by SFH. I was thrown right back by her forthrightness in saying that the system of asking people to test 'publicly' is what discourages most people from testing. She said that she would not, for example, ever test publicly but would willingly test privately and individually any time. One of her reasons was that one never knows how one might react to the test results.

Even as I gave her and the audience, my usual spiel that it is not a positive result that people are afraid of, as much as the stigma of other people knowing that they have had sex (probably 'illicit' sex), I knew I was not being very convincing to her. (During and after the meeting, SFH counsellors tested 105 people which meant that at least some people were convinced and made use of the testing facility provided for the occasion).

As I drove back home to Shimabala, I reflected at length about the young lady's strong sentiments. I also related her strong sentiments to how some individuals who are found to be HIV positive find it nigh impossible to disclose this to those close to them - sometimes even their sexual partners.

As I reflected, I remembered Fr Michael Kelly's advice (quoted above) which I use in a lot of my presentations. This advice relates to why we seem to still have problems reaching people with HIV messaging - that we perhaps do not speak enough and convincingly to the individual and personal being in people.

To ask anyone who is, or has been sexually active to take an HIV test, especially publicly (as at a large VCT Day meeting or event), or in the presence of a number of other people (as say in attesting centre), is to ask them to make a public statement that that they have had or are having sex. In a culture where public discussion or admission of sex are near taboo, this may be asking a lot. Taking a test is almost a sexual 'behaviour' on its own and as the young lady at Lubengele Hall stated, should it therefore be as private and individual?

But then if it is indeed bordering on cultural taboo, why was it that at the meeting of councillors and senior staff only six people (two councillors and four staff) tested out of about 40; whereas at Lubengele 105 people cued up, joking and jostling publicly to test? Why is it that when VCT services are taken to rural Zambia, people will willingly cue up for hours (sometimes with their spouses) to get tested? Is it more culturally acceptable in the rural setting to make a public admission of having sex? Is stigma or the fear thereof less outside the urban areas?

My wise teacher, Fr Kelly is quite right. New HIV infections, subsequent AIDS-related illnesses and deaths, will be stopped only if and when individual persons make the personal decision to change their sexual behaviours. As I always say, at that moment, just before the virus gets sexually transmitted or acquired, one is alone and so is their sexual partner. Even if they agree to do something together (protection-wise) they each must make an individual decision to agree. At that moment when it is critical to make the right choice or decision, there is no counsellor or activist with HIV prevention messaging - except in the individual's memory.

What is it that we can do better to reach individuals at that critical moment to empower them and help them change their sexual behaviour?

The same goes for the decision to test or not to test. Are people more likely to make the individual, personal choice to test in a more individual and private environment? What is the experience with door-to-door testing that has been tried in parts of our country? Why do we not hear more about it? Should we be doing more of that everyday, everywhere? Should we be doing more of that on national VCT days and other public occasions and events? Should we even be having these expensive national events and occasions at all?

The theme for National VCT Day was about 'reaching everyone everywhere with VCT services'. My question is, 'how can we reach individuals everywhere to help them change individual sexual behaviours'?

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Source: the Post Online