In-depth: Beyond ABC: The challenge of Prevention
NIGERIA: Changing behaviour not impossible
HIV awareness campaigns are not reaching everyone effectively
ABUJA, 14 November 2005 (IRIN In-Depth) - Correctly informing people about HIV/AIDS and getting them to alter the kinds of behaviour that help to spread the pandemic is possible - as long as the messages are adapted to the target audience.
"Look at this!" exclaimed Mohammed Sagir Auwal, project coordinator for STD/AIDS Awareness and Prevention, as he waved a textbook in the air. "According to them, a child in primary school should be able to recognise genital organs, know what a penis or a vagina is, and how babies are made!"
The textbook, the National Family Life and HIV Education Curriculum, was developed by the state-run Nigerian Council for Research on Education and Development to teach students in primary and secondary school.
"This book does more harm than good: if I explain to my five year-old son how babies are made, he'll want to try!" said Auwal, adding that he and other members of the Muslim community in Kaduna, about 200 km north of the capital, Abuja, were refusing to use the textbook or to let their children get their hands on it.
With an official HIV infection rate of five percent, or about four million cases nationwide, Nigeria has the world's third highest number of people living with the virus, after India and South Africa.
In spite of numerous awareness campaigns organised over the last few years by the National AIDS Action Committee (NACA), authorities documented 200,000 new cases in 2004.
MESSAGES MISS THE MARK
A number of AIDS activists have said the continued spread of the virus in Nigeria can be explained in part by the fact that by trying to reach everyone, HIV awareness campaigns are not reaching anyone effectively.
Even when rural populations have access to campaigns on television, radio or billboards, the messages are often in English, a language that is far from universally understood in a country where the UN estimates over a third of adults are illiterate.
Moreover, impersonal or overly vague messages miss their mark because they fail to account for the age, culture or socio-economic situation of the intended audience, according to experts.
"There's not much use in talking abstinence to someone who's already sexually active," said Andrew Yohanna of NACA's state-level counterpart, SACA, referring to ABC - for 'abstinence, be faithful and condomise' - the most widely promoted prevention technique.
"In the same way, talking about being faithful with young singles doesn't make much sense - it's better to discuss condoms," said Victor Ogbodo who runs 'Changing Behaviours' for the Global HIV/AIDS Initiative Nigeria (GHAIN), a programme financed by the US government.
The choice of words is also key, especially in Nigeria's predominantly Muslim North, where, according to SACA, there is great reluctance to discuss sexuality openly, particularly among women.
"Around here, when a girl has her first period, her mother will never say 'Don't have sex'," said Auwal. "She'll use other expressions like 'Don't let any man come close to you' or 'Don't let him touch your hand' - with the understanding that this means 'Don't let him go further'."
Beyond the content of a message, the choice of messenger is also crucial, because a person who belongs to a given community will know the best way to approach a particular subject.
In the North "for a long time, HIV awareness campaigns were seen as a way for the West to spread foreign ways of thinking among traditional Muslim communities," said Auwal. "It's important to give community leaders the freedom to formulate their own prevention messages."
"If you ask these leaders to participate in the creation of messages, they won't turn down" the opportunity to inform their communities on the pandemic, he advised. "Their support is necessary because they are so respected."
GETTING THE WORD OUT
Auwal said he was working with other members of the community on a booklet with the same aim but using different language, to replace the controversial textbook.
GHAIN's Ogdobo agreed with the importance of using the right words with the right people, but thought certain things needed to be said without any "hypocrisy".
"What's wrong with naming things that everybody knows?" he asked. "By not using the right terms, we run the risk of creating confusion."
It's important for people to accept that if they have sexual relations with multiple partners, there's a chance they'll be infected with HIV, Ogbodo commented. And for that to happen, an open discussion is necessary.
The first step in getting people to change their ways was to understand why those that are well informed continued to engage in high-risk behaviours, he said, pointing to the relatively low rate of condom use.
"On this point, for example, we asked some MSM (Men having Sex with Men)," said Ogbodo. "They say that condoms are not adapted to them, that they're too thick, so we'll have to see what we can do to fix that."
But changing behaviour patterns also requires changes in health habits, not just sexual ones.
Nigerians "go to the hospital rarely, if ever", according to Ogbodo - a trend that is even clearer when it comes to HIV testing clinics.
Rather than trying to convince people to go to these clinics, he believes it makes more sense to concentrate on why they are staying away.
The perception of hospitals as "unfriendly" places, the fear of discovering that one is HIV-positive when access to treatment is very limited, or the reluctance to be seen at an "AIDS centre" all seem to discourage Nigerians from being tested.
The GHAIN project is trying to make certain hospital testing centres "friendlier" places, where people go for a number of different reasons.
A campaign called "Heart to Heart", using warm colours and messages of hope, is set for a November launch to promote the centres.
"Nobody is ever really ready to hear about AIDS or learn that he or she is infected," said Ogbodo. "But given the extent of the pandemic, we can no longer allow ourselves to be unprepared."