In-depth: Beyond ABC: The challenge of Prevention
ANGOLA: Racing against time to prevent HIV/AIDS rate from rising
Photo: IRIN
Driving home the safer sex message is vital
LUANDA, 14 November 2005 (IRIN In-Depth) - Condoms are embarrassing to buy, they spoil sex, and if your partner insists on using one then they obviously don't trust you.
It's a familiar refrain the world over, but in Angola, where hammering home the safer sex message is vital if the country is to avert a widespread HIV/AIDS pandemic, making condoms widely available and 'cool' to use is paramount.
Ironically, Angola's 27-year civil war insulated the country from the virus, but the end of the conflict has seen refugees return from neighbouring countries with higher prevalence rates and has encouraged people to move around within Angola's borders, sparking fears that they could take HIV/AIDS with them.
The latest government figures put Angola's HIV/AIDS prevalence rate at less than three percent, a remarkably low figure compared to the double-digit rates in many other African countries, but there is scant research on the true extent of the problem and many doctors, researchers and humanitarian workers privately believe the real rate is much higher.
Scare stories abound, particularly in the provinces, where there are reports that HIV/AIDS is regarded by some as a form of witchcraft or even "God's punishment". Condoms as a contraceptive are sometimes frowned upon in Angola's catholic society, while a misplaced belief that the disease can be spread by mosquito bites means some people see no point in protecting themselves.
But the news is not all bad, particularly among the urban youth, where education efforts appear to be working.
"Using a condom is much safer for everyone - we are taught that in school, and we take in all the advertisements on television and radio," said 17-year-old Beto, who wouldn't dream of having sex without a condom. "I don't believe there is a single young person - in Luanda, at least - who is not aware of HIV/AIDS and why they should use condoms to avoid it."
That may be music to the ears of those seeking to curb the spread of the disease, but the effort to break down concerns that condoms reduce pleasure and can cause irritation needs to be maintained.
"Access to condoms has improved a lot in the last three years, but there are still some cultural barriers to condom use," said Dr Alberto Stella, the UNAIDS Coordinator in Angola.
While Angola's urban youth seem to be aware of the theory, there is still a sense that HIV/AIDS is something that happens to someone else.
"People know about HIV/AIDS, and well over half the youngsters we talked to were personally worried about catching HIV/AIDS, yet when we asked them if they thought they were at high risk, they said 'no'," said Diana Gourvenec, Research Director at Population Services International (PSI), an NGO that makes condoms available at highly subsidised prices.
PSI distributed more than 10 million condoms in ten of Angola's 18 provinces last year at just five kwanzas (less than 10 US cents) for a pack of four, so cost is not a barrier to use.
"You can buy condoms very easily here in Luanda - at almost any store or pharmacy - and they are cheap, so we have no excuse not to use them," said 20-year-old Ernesto.
But PSI estimates that just 55 percent of Angola's youth used a condom last time they had sex with a casual partner, a figure that drops dramatically if the partner is classed as a boyfriend, girlfriend, husband or wife.
"It's embarrassing going to the shop and buying them, and I really only use them so my girlfriend doesn't get pregnant - she would be upset if she thought I thought I could catch something from her," Ernesto said.
His condom use is erratic because he doesn't want to offend his girlfriend, whom he trusts implicitly even though they have only been seeing each other for two months.
Ernesto's eagerness to impress means he prefers to buy "decent" branded condoms, but at 250 to 300 kwanzas for a box of four, or 50 to 60 times more expensive than PSI's 'Legal' brand, he can't always afford them.
"Some people associate low price with low quality, although a condom is a condom," Gourvenec said. "But people want a bit more choice, so we're going to put something out in the market to appeal to people who have a bit more disposable income and who like the idea of buying something better."
That's all well and good in Luanda and other urban centres, but many fear that youngsters in the provinces, who haven't had as much access to the information and education campaigns, could be sitting on an HIV/AIDS time bomb.
"We know all about it here, but I'm not sure the kids living in Huambo [province in south-central Angola] or Cunene [province in the south] get the same information," said Beto.
"I think it is possible that Angola can escape the kind of levels we have seen in Botswana and other countries, but only if the government keeps telling people how dangerous it is, and makes sure that everyone across the country understands," he commented. "Then we have a chance to avoid this."