AIDS-related deaths: How to get to Zero in Africa's rural areas

UNAIDS' latest report is upbeat about the future prospects for a world with zero new HIV infections and zero AIDS-related deaths. Such aspirations also imply 100% access to antiretroviral drug treatment (ART). Although Sub-Saharan Africa accounted for 70% of all new HIV infections in 2010, there is said to be a decline in the regional rate of new infections. For example in countries with high exposure, such as Ethiopia, Nigeria, South Africa, Zambia and Zimbabwe, this rate has declined by more than 25% in the past 10 years. Nevertheless, more than 50% of Africans who are already HIV+ are unable to access treatment. Most of these unfortunate people reside in rural areas, where it is many hours’ walk to the nearest clinic. For example, research has shown that a vigorous treatment programme has led to the decline of HIV in Botswana’s urban areas, while prevalence in the rural areas has remained unchanged. It is estimated that the need for ART in Botswana will increase by 60% by 2016.

Men have proven to be the hardest group to reach, as far as providing successful treatment is concerned: Workers in Malawi have shown that men only go for treatment once they are ill. This means that their disease is often too advanced to benefit from successful treatment. And, whereas women, particularly mothers, are motivated to seek voluntary counselling and testing, men are much more reluctant to go, probably because of the stigma that they will attract. To make matters worse men are also more likely to migrate in search of work and this reduces their adherence to treatment, leading to higher mortality from AIDS.

UNAIDS recommends community-based, participatory learning approaches in order to challenge social gender norms that increase vulnerability to HIV/AIDS. 

Hundreds of rural communities, across Africa have already benefitted from ‘Positive Living’ participatory workshops, where women, men and young people learn how to reduce their vulnerability to HIV, ways to ensure a healthy diet and how to prevent diseases associated with poor hygiene and opportunistic infections. The training manual - How to Live Positively, which is used to facilitate these workshops was written by me and Fortunate Nyakanda; it increases treatment preparedness and carries a message of hope that reduces the fear that leads to stigma. The How to Live Positively training manual can be downloaded in English for free here, or obtained in French, Portuguese or English, from CTA.