HIV/AIDS | White Paper World Youth Alliance

"UNAIDS, a United Nations body with a lot of political and financial weight, has continued to promote strategies that often do not address the fundamental underlying behaviors that facilitate the spread of HIV. The need is urgent for locally driven campaigns that are aimed at stopping risky behaviors and cultivating a culture of personal responsibility. In order for these campaigns to be effective, they must respect local cultures and engage community leaders."

This paper from the World Youth Alliance discusses HIV politics and policy in Sub-Saharan Africa. [Footnotes are removed throughout by the editor.] "This paper first presents an overview of how HIV is transmitted, statistics on how many people are affected by HIV/AIDS, and the differences between prevalence and incidence and generalized and concentrated epidemics, critical for understanding how to respond appropriately and effectively in various contexts. Next, it details the elements of a person-centered response, particularly risk avoidance, which is based on a holistic perception of the person’s needs in prevention, treatment, care, and support and underscores the capacity of the person to make responsible choices that greatly reduce the risk of transmitting or contracting HIV. It explores the importance of local development of intervention strategies in effectively communicating to and meeting the needs of the person. The paper then focuses on the success of antiretroviral therapy (ART) in treating those infected with HIV, strategies that effectively curtail the risk of HIV transmission, namely reducing multiple concurrent partners and delay of sexual début, and strategies that can only reduce the risk of HIV transmission, such as circumcision, condom use, and voluntary counselling and testing. Finally, the paper describes UNAIDS’ successes in promoting access to ART and its failures in overprioritization and promotion of interventions that have not proven the most effective in generalized epidemics."

In the section "Elements of a person-centered response to HIV/AIDS", the paper emphasises focusing on the intrinsic dignity of the person: "The effectiveness of prevention interventions lies in the way in which they respond to the capacity of the person to make responsible choices....The goal of HIV prevention is ultimately to build a culture of individual responsibility, and to foster programs that go beyond mere harm reduction strategies." This means a focus on the science of prevention and choices that avoid risk. The paper cautions that those who emphasise harm reduction strategies are sending a message that they are giving up on at-risk populations. However, it supports risk avoidance strategies focused on "changing the underlying behavior that puts a person in a position of harm. While behavior change is an essential component of any approach to the prevention of HIV transmission - primary behavior change is a specific subset of these behavior changes that is concerned with risk avoidance."

The intervention strategies recommended are local "home-grown" strategies. "Responses to HIV/AIDS epidemics are most successful when they come from within the affected communities themselves, and person-centered responses in particular are most appropriate if they understand the context in which the infected person lives...[For example,] Uganda’s successful community-based response is particularly well-known and lauded, with organized mobilization by 'faith based organisations, prominent cultural figures, political, military and community figures, non-governmental organisations (NGOs) and care organisations'....Many times, messages approved by Africans are changed by Westerners who think they have a better idea about what will get the message across, or there is no input or feedback from Africans. Many HIV prevention messages designed by well-intentioned Westerners are highly sexualized and based on an ideology focused on sexual and reproductive rights. This can cause those who recognize that their own behavior is not 'promiscuous' to reject the idea that they are at risk of contracting HIV. Furthermore, culturally inappropriate messages can cause people to feel ashamed of their behavior and thus to refuse to undergo testing or to receive care.”

The paper concludes by recommending that UNAIDS: embrace evidence-based interventions rather than over-rely on condom promotion; focus on person-centred messaging, including, where appropriate, delayed sexual début and partner reduction; treat with antiretroviral therapy; and continue to support people living with HIV/AIDS.