SOUTH AFRICA: Positive prevention
Photo: LoveLife  |
| National prevention campaigns don't target HIV positive people |
JOHANNESBURG, 7 December 2006 (PlusNews) - After Zodwa [not her real name] learned she was HIV positive, six torturous months passed before she felt able to tell her boyfriend. "I had to check his mindset," she said. "We were using condoms, but I worried about the condom breaking, and I felt so guilty." As it turned out, her boyfriend was supportive, but the couple broke up a few months later.
"I was very uncomfortable having sex, so it affected the relationship," Zodwa said. "Now I'm in a relationship with someone who's positive and it's easier, but it took time to think of sex normally."
As more and more HIV-positive South Africans access free antiretroviral (ARV) treatment and look forward to healthier lives, love and sex inevitably regain importance. The challenge to healthcare providers is to recognise the human right of such people to have sex, while helping them to mitigate the risks.
Even for couples where both individuals are HIV-positive, unprotected sex carries major health risks. People infected with HIV are more susceptible to sexually transmitted infections (STIs) and there is the possibility of reinfecting a partner with a new or drug-resistant strain of the virus. Besides non-penetrative sex, the only protection against such risks currently available is male and female condoms.
"Women from our support groups who continued to have [unprotected] sex with their partners - they're not with us today," said Prudence Mabele, director of the Positive Women's Network, an organisation of women living with HIV. "We need to talk about positive prevention because, for a long time, I didn't think prevention was catered to me."
Large-scale prevention initiatives tend to focus on the general population, who are assumed to be either HIV negative or unaware of their positive status. The Social Aspects of HIV/AIDS Research Alliance (SAHARA) is conducting a study in eight African countries to test interventions aimed at reducing the risk behaviours of people who know their HIV-positive status.
Results from the first phase of the study found that of the 1,054 HIV-positive men and women surveyed, 85 percent were sexually active. Of those, 42 percent reported that in the last three months they had had sex with a person they had not told about their status. Most significantly, the study found that participants who had not disclosed were much more likely to have engaged in risky behaviour, such as having multiple partners, having unprotected sex and not knowing the status of their partners.
According to Dr Leickness Simbayi, a senior researcher at South Africa's Human Sciences Research Council and coordinator of the study in four countries, stigma and discrimination that prevented people from disclosing their status was the biggest barrier to their ability to practise safe sex.
Fear of disclosure was often motivated by real events. Forty percent of participants had experienced discrimination and one in five had lost their homes or jobs because of their HIV status. Gay men reported even higher levels of discrimination. The feelings of shame and depression that characterise internalised stigma were also prevalent and contributed to unsafe sexual practices.
The next phase of the SAHARA study will test two interventions aimed at helping people living with HIV/AIDS (PLWHA) to cope with stigma, disclose to their partners and avoid risky sex. One will use a support-group model encouraging participants to share skills and experiences; the other will use one-on-one sessions with counsellors.
HIV-positive people often report getting more information on sexual and reproductive health from their support groups and HIV-positive friends than from counsellors and health workers.
"Most healthcare workers have very negative attitudes," said Zodwa. "The minute you say you have an STI they're very judgmental, even though it could just be an opportunistic infection."
Apart from the need to address these attitudes and to provide more training, Simbayi believes that overwhelmed counsellors simply lack the time to go into such issues with their clients. "Perhaps if there were enough counsellors, part of the need for additional interventions would not be necessary."
Apart from a few minutes of post-test counselling, which should include safer sex information, PLWHAs will often not speak to a counsellor again until they begin ARV treatment. At that point, the discussion will mainly revolve around drug adherence and side-effects.
"We're constantly encouraging people to test and know their status, but when they do, and they learn they're positive, it's like 'good luck'," said AIDS activist Mark De Clark. "Many people don't know what living positively really means."
Catherine MacPhail, a senior researcher with the Reproductive Health and HIV Research Unit at the University of Witwatersrand, in Johannesburg, believes HIV management should move towards a more holistic approach that integrates treatment and care with education on prevention and fertility issues. "We've got to help people maintain safer sex practices for the rest of their lives," she pointed out.
MacPhail is developing a trial intervention, similar to the counsellor-based one SAHARA is about to test, using a technique called 'motivational interviewing' to help PLWHAs assess their risk behaviours and make choices about how to change them one at a time.
Mabele said positive prevention approaches should also be sensitive to the fact that PLWHAs, especially those newly diagnosed with the virus, have complicated feelings about sex that may include anger, fear and denial. "After learning my status, sex equalled death and I abstained for three years," she recalled. She knows of others who reacted by refusing to take responsibility for infecting their partners.
De Clark, who was in a stable relationship when he learned his HIV-positive status, described going through a difficult period with his partner. "He was scared of being infected and I was scared of infecting him. For a long time the only way we could cope with it was to have no sex." Five years later, De Clark and his partner are still together, "but even today there's still that fear, so you become extra careful and your sexual relationship becomes a bit stilted."
Mabele believes discussions about safer sex should become less clinical: "Just because you've been diagnosed, it doesn't mean you stop feeling," she said. "Besides this virus, sex is supposed to be pleasurable."
With these goals in mind, her organisation runs occasional 'love parties' - workshops where positive women can discuss ways of putting some fun and romance into safer sex. "It's partly to get people over their embarrassment about these things," said Mabele. "Our culture doesn't talk a lot about sex, so we need to break that."
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Theme(s): (IRIN) Prevention - PlusNews
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[This report does not necessarily reflect the views of the United Nations] |
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