ATHENS, Ga. - In the United States, AIDS is increasingly seen as a chronic disease that can be treated for years with new drug combinations. No longer is the Human Immunodeficiency Virus, which causes AIDS, seen as a death sentence.
That new optimism is not shared in Africa, where, for many reasons, the disease is at the pandemic stage. An astounding 67 percent of the individuals on Earth with HIV/AIDS live in Sub-Saharan Africa. In 1998 alone, four million adults and children in the area were estimated to be newly infected with HIV. Some two million people died in Sub-Saharan Africa from AIDS in 1998, according to the World Health Organization.
A new study, involving by a faculty member at the University of Georgia, has found that one reason for the high infection rates may be the failure of educational efforts to help halt the spread of AIDS along the Trans-Africa Highway. Those efforts, both by African and international health organizations, have raised concerns about the disease but have failed to take the next step: providing practical help such as condoms.
"Providing a fear message without follow-up is worse than no message at all," said Kenzie Cameron, an assistant professor of speech communication. "These messages alone won't solve the problem and have the potential to make it worse rather than better."
The research, with co-authors Kim Witte and Maria Knight Lapinski of Michigan State University and Solomon Nzyuko of the African Medical Research Foundation in Nairobi, was just published in the International Quarterly of Community Health Education.
The selection of study sites along the Trans-Africa Highway was quite deliberate. Truck stops on the highway have long been the location of commercial sex workers, who have numerous partners among those who work in the long-distance hauling industry. The combination of multiple sex partners and a lack of condoms has made these truck stops somewhat notorious as places where HIV and other sexually transmitted diseases abound.
In the summer of 1995, Cameron and her colleagues went to Kenya to set up focus groups in three Kenyan towns on the Trans-Africa Highway: Simba, Mashinari and Malaba. With the help of Nzyuko, a health educator who knows the area well, the team set up discussion groups at truck stops in the three towns among three distinct groups of people: commercial sex workers, truck drivers and young men who live and work at the truck stops. (Cameron said the term "commercial sex workers" instead of "prostitutes" is quite deliberate, since there is a cultural distinction involved. Husbands of the sex workers, she said, consider their wives' work as just another job, without the moral stigmas attached in most western civilizations.) A total of 64 individuals participated in the study, ranging in age from 17 to 57.
"Many researchers have noted that for campaign messages to work, they must target specific knowledge, beliefs and perceptions held by target audiences," said Cameron. "So we had to determine if the people living or working along the highway believed themselves to be vulnerable to HIV infection and whether or not they think condoms will work to prevent HIV."
Speech communication researchers have developed numerous models to explain how messages get across to target audiences. Many such message fail because they carry incomplete information, address problems incorrectly or fail to provide solutions. On the Trans-Africa Highway, the problems run much deeper.
There have been considerable efforts by many organizations to inform the public that unprotected sexual intercourse is the primary method in which HIV/AIDS is spread. Rather than using tested communication models, however, those involved have largely developed educational materials by "brainstorming." Although some effective messages can emerge from such sessions, ineffective messages making the problem worse are just as likely to emerge.
After extensive interviews with the discussion groups, the research team used the Extended Parallel Process Model (EPPM) to evaluate why the "fear" messages have been so ineffective slowing the spread of HIV/AIDS in Sub-Saharan Africa. The EPPM suggests that a fear appeal elicits two responses: an appraisal of the threat and an appraisal of how well recommended responses work.
According to this model, much is being done wrong in the hotbed of HIV/AIDS to stem the threat of a growing pandemic in the area. According to the EPPM, any campaign message must include both a threat and a way to lessen the threat. While public health messages have made the threat clear, little or nothing has been done to stem the threat by making condoms widely and inexpensively available in the area.
The study began simply by asking participants which are the most significant health threats in the area. Although some people mentioned HIV/AIDS immediately, many were more concerned with malaria, skin problems or even Ebola disease. Eventually, however, HIV/AIDS was mentioned in all the groups, and the researchers soon found there was a potent mix of knowledge, misinformation and suspicion that was seriously harming public health efforts to slow the spread of the disease. A stunning 83 percent of those in the group "thought it possible or probably they themselves had the virus," though few had been tested.
"Overall, participants appeared to know how HIV is transmitted, though several people believed that sharing utensils or toothbrushes and even mosquito bites can cause the disease," said Cameron. "A concern was even raised that transmission was through the condoms themselves." (Oddly, one message gaining some currency was that "AIDS" is an acronym for "American Idea of Discouraging Sex," which some used to dismiss the reality of AIDS completely.)
While many myths about transmission still exist, Cameron and the researchers found that motivational campaigns to change behaviors will do little good in the area as long as inexpensive condoms are not made available. The team said condoms should be made available at a variety of locations, 24 hours a day, at affordable prices. In addition, condom storage must be improved to prevent breakage due to heat and moisture damage - a serious problem in the area's climate.
New workshops and seminars should likewise be developed to promote greater condom use, and innovative methods should be designed to train truck drivers, their assistants and young men on the proper use of condoms and how to minimize breakage problems.
The authors are careful to admit that the small size of their discussion groups makes generalizing from the information of limited use. Cameron plans to design groups with larger representative samples to confirm the information presented in the current research paper.
Despite numerous HIV/AIDS prevention campaigns in Kenya, the disease continues to spread rampantly. In 1993, some 760,000 Kenyans were estimated to have HIV. Just two years later, nearly one million were believed to be infected, even though large-scale campaigns to fight the disease were underway. Clearly, a new method of getting the message across, along with a way to solve to the problem, is crucial if the disease is to stop ravaging the continent.
WRITER: Phil Williams, 706/542-8501, philwpio@arches.uga.edu
CONTACT: Kenzie Cameron, 706/542-0586, kcameron@arches.uga.edu
Journal
International Quarterly of Community Health Education