In-depth: Beyond ABC: The challenge of Prevention

SOUTH AFRICA: Life, love and prevention after HIV/AIDS

Photo: IRIN
Connecting After Testing Positive For HIV
JOHANNESBURG, 14 November 2005 (IRIN In-Depth) - South Africans are finding that being HIV-positive is not the end of living and loving, but despite the provision of pre- and post-HIV test counselling, no effort is being made to address how HIV-positive people should negotiate the dating game.

Untold truths of life and love after HIV/AIDS

Jesse (name changed), who is HIV-positive, said this oversight reinforced a belief that infected individuals would lose their libido in the myriad of emotional and societal challenges they faced.

"There was a long period after being diagnosed that I felt unattractive. Physically, I became a shell of my former self and sexual intimacy was the last thing on my mind, so prevention was never an issue at that time. But not long after starting on antiretrovirals [ARVs], my appetite, weight and sexual interest was again revived," he told PlusNews.

Although serving as a green light for Jesse to push on with his life, the accompanying sexual re-awakening presented weightier considerations.

In his search for gratification, Jesse became engaged in a tug of war between disclosure and almost inevitable rejection, or the choice of using a condom and keeping his status secret.

"Having to tell your family or close friends is easier because they usually accept you, no matter what. But your relatives can't satisfy your sexual needs, and the full implications of having to disclose is only really grasped when you try to feed your sexual hunger."

The sting of rejection quickly cancelled out any guilt he felt in keeping his positive status from casual sex partners ... provided condoms were always used.

"But even after condom-use you are left wondering whether or not you infected the other person - conflicting views that condoms might not be as safe as we would like to believe only adds to any feelings of guilt."

He found it disturbing that HIV-positive people might still be having sex without protection, despite evidence of rising AIDS rates and warnings about reinfection.

"I was not adequately prepared for life or sex after AIDS, and it would have been much easier if there were some way of knowing whether the other person was also HIV-positive," he said.

Different strokes for different folks

Ben Sassman, the founder of Positive Connection, a non-profit website that offers people like Jesse a chance to share experiences and maybe even find a partner again, told PlusNews that he knew only too well the emotional pain suffered by friends living with HIV/AIDS.

"HIV-positive people are living longer productive lives as a result of the ever-increasing availability of ARVs. With this renewed lease on life also comes a need for love and fulfilment, sexual or otherwise. These needs make it important for HIV-positive people to not only pay close attention to their own health and safety, but also to that of their partners. This site tries to serve as a guide for those people who might have been sidelined by prevention campaigns," he said.

Photo: IRIN
"True Love Involves Me"
According to Sassman, the site was unique in that it promoted prevention and safety by encouraging subscribers to be honest about their HIV status, but at least 36 dating sites currently operating in South Africa cited the promotion of stigma as a hurdle for failing to do so.

Arguing that stigma would always be there, Sassman noted that HIV-positive people should at least have the choice of going through life with rejection by uninfected people, or with the love and support of someone also living with AIDS.

"People are led to my site by fear of rejection in the outside dating world, where they found that after disclosing their dates would make excuses not to see them again. It is not like letting a date know you have a serious non-infectious disease. For many people, becoming romantically involved with an HIV-positive person raises concerns about physical safety," he commented.

Concerned that people could easily become reckless as their confidence in the life-prolonging abilities of ARVs increased, Sassman urged anti-AIDS campaigns to revisit prevention when tackling the pandemic.

Ready or not ... here we come!

The startling results of an annual global survey released in November 2005 by condom producer Durex has also raised questions about the efficacy of prevention campaigns.

According to the 'Durex Global Sex Survey', conducted online among 317,000 people in 41 countries, a large portion of already hard-hit South Africa was still engaging in unprotected sex without any knowledge of the partner's sexual history.

The findings showed that the proportion of unsafe sex - an estimated 64 percent - was much higher than the global average of 47 percent.

"When compared to last year's results, the statistic is higher, which means that South Africans continue to take risks and put their lives in danger," said Durex in a statement accompanying its survey results.

In its 'HIV and Syphilis Antenatal Sero-prevalence Survey' for 2005, the department of health said between 6.29 million and 6.57 million people were living with HIV/AIDS by 2004 - far higher than the recent 4.5 million estimated by the government statistics agency, Stats SA.

Doctor always knows best

Professor Alan Whiteside, director of the Health Economics and HIV/AIDS Research Division at the University of KwaZulu-Natal, said that although anti-AIDS treatment was a critical part of tackling the pandemic, the importance of prevention should never be forgotten.

"By just treating the disease we are not addressing the root cause of it, which is people contracting the virus. The whole question of prevention is in danger of being lost, not just by government, but by the overall public. If we take our eyes off the ball for even a short while, we will have lost," he told PlusNews.

Whiteside noted that prevention for HIV-positive people had not received the attention it deserved, and warned that this not only posed a threat to people living with AIDS, but also to future generations.

"We have to consider the dangers of reifection among HIV-positive people, as well as the possible emergence of new strains of HIV. This would also raise huge concerns about the ability of current treatments to fight a new and possibly stronger version of the HI virus."

Highlighting that there was no sign of the pandemic being brought under control in South Africa and neighbouring countries, he recommended that officials focus on rolling out prevention together with antiretrovirals.

"The issue of prevention, however, should not rest solely on the shoulders of government," Whiteside said, "as it has a great deal to do with individual choice."
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