When tragedy befalls us, it is our tradition to defend ourselves either through defense of society or singing songs of war and courage to send the mighty warriors to protect their people.
One such tragedy is the Aids scourge in the early 1980s and 1990s. Two prominent warriors sung for the defense of their nations: Philly Bongole Lutaya and Franco Luwambo of TP OK Jazz. The later was the first to sing about HIV/Aids through the Team of Le Grand Maitres. Their most powerful song, was Attention Na SIDA (Be Careful of Aids). It was sung way back in 1987 when HIV was a new phenomenon – perhaps known for only two to three years. The song was powerful, informative and much needed message at the time.
Franco exhorted everyone to take the disease seriously, governments to educate the people and everyone to change their behavior. One big message, which remains relevant to date in his lecture amid his beautiful guitar sound ,as he thunders his message like an old testament prophet telling Sodom and Gomorrah to repent or perish.
To re-purpose Franco’s lyrics for today’s relevance and to acquire a proper target his first chorus Benda nzoto ngai na benda nzoto mama, Benda ya yo ngai na bendi ya ngai’ (translated as look after your body and I will look after mine, protect your body and I will protect mine). Very simple and straight forward message but often ignored.
In acquiring our new targets, there has been interest in understanding what may have led to Uganda’s dramatic decline in HIV prevalence. The world’s earliest and most compelling Aids prevention success.
Survey and other data suggest that the decline in multi-partner sexual behaviour is the behavioural change mostly associated with the decline ‘keep your body and I keep mine,’ which would loosely translate as promotion of ‘Zero-grazing’, (faithfulness and partner reduction strategies).
Let’s consider further the debate over ‘What happened in Uganda’, is divisive abstinence versus condom use rhetoric, the same as ‘keep your body and I keep mine’. Assuming, in the ABC battle strategy against this HIV/Aids war would ‘A’ (abstinence) be a better target acquired than ‘C’ (condom use-correctly and consistently). Let’s go through the five battle strategies to acquire our likely targets to defeat HIV/Aids.
In the first instance, scholars have proposed radical and sustained behavioural changes in sufficient number of individuals potentially at risk, is needed for successful reductions in HIV transmission.
Second, combination prevention: widespread and sustained efforts and a mix communication channels to disseminate messages to motivate people to engage in a range of options to reduce risk.
Third, prevention programmess can do better: Effect of behavioural strategies could be increased by aiming for many goals (eg delay on onset of first intercourse, reduction in number of sexual partners, increase in condom use etc.) – and multi-level approaches (eg couples, families, social and sexual networks, institution and entire communities) – both uninfected and infected population.
Fourth, prevention can do better: intervention derived from behavioral science have a role in overall HIV prevention efforts; and lastly, get simple things right: the fundamentals of HIV prevention need to be agreed upon, funded, implemented, measured and achieved – not the case presently.
On all the target practicing we have seen above; partner reduction and HIV prevention has remained unsupported. Scholars have put it right that, the most effective strategies come from within communities (Shelton et. al., 2004).
Reaffirming the truth that without multiple sexual partnership, an HIV epidemic would not occur and that by extension, partner reduction is the most obvious, yet paradoxically neglected approach to HIV prevention.
Dr Elima is the director, Gulu Regional Referral Hospital.