Wednesday, September 23, 2020

The missing links in the war against HIV/AIDS

Dear Editor

In my opinion, a major missing link in this war against HIV/AIDS in most African countries is that Governments and their partners have missed providing the clear reasons, tools and the means for citizens to change their behavior.

Millions have been spent to provide services, staff, and medications that assist in combating the scourge of HIV/AIDS. The US Government, Bill and Melinda Gates, Harvard University, Merck, UNAIDS, WHO and other entities have joined hands with Africans and have provided needed funds, needed expertise, needed skill sets, needed specialized leadership, and ongoing encouragement to African Governments and their citizens yet the pandemic has not slowed; the infection rate has not decreased; Africans are still contracting the disease in alarming numbers and the funeral business is still one where the money is.
The human person resists behavior change.

It’s very hard and often emotionally painful work that requires commitment, guidance and time. A person will not generally commit to change until being sure how they are and doing what they do generates more pain than pleasure. Some of you have tried to change your eating behavior ÔÇô how consistently successful have you been? Some of you have tried to change your drinking behavior ÔÇô how consistently successful have you been? Some of you have tried to stop smoking ÔÇô how consistently successful have you been? Some of you men have recognized your need to stop your womanizing and to consistently use a condom when having sex ÔÇô how consistently successful have you been? Some of you women have recognized the fear that washes over you in the morning after a night of drinking and sex with an unknown partner or with a partner that you know is sleeping around. But, often, the behavior continues.

Raising awareness, suggesting that persons change, telling persons to change, and actually helping those desiring change to change, are very different things.
Additionally, the pain of consequences needs to be generated by the enforcement of law and Government policy.

The pain of consequences is what can motivate people to seek change and seek the joy which people find as they stop knowingly harming themselves and others and practice new and healthy behavior.
There has been successful promotion of increased awareness of the facts of HIV – how one contracts it, how one can avoid it, what one can do to help themselves if they have it. Voluntary testing centers have been provided, but are underutilized and treatment with ARVs is available to many African citizens who have tested positive to HIV. They are also underutilized. The Governments and their international partners have also repeatedly pointed out that there must be a significant change in behavior if this war is to be won. Simple awareness of facts does not equal a person being motivated or equipped to make significant change in their attitudes, beliefs, and behaviors.

What has not been done is to solidly, and without equivocation, identify those behaviors which must be changed and to describe that change. From what – to what and how do I do it? What has not been done is to ensure, through enforcement of law, that bad behavior is followed by the pain of consequences. If there is no pain in what a person is doing, why then would they consider change? Let’s say a man has become HIV positive but he does not know that because he refuses to get tested. He continues to sleep around. He infects all the women he now sleeps with. They don’t know it yet, he doesn’t know it yet and, basically, there is no immediate or later personal consequence to his behavior except his own eventual death from the illness. What is his motivation to change? The immediate gratification of sex far outweighs any occasional fear he may experience as he wonders about his HIV status.

What has not been done is to provide funding and guidance and ongoing support to people and programs which actually motivate, teach and facilitate the methodology and the hard work of changing behavior. Talk is cheap. Many people talk of behavior change; few know how or have the experience to facilitate it happening. In a war, theories are useless ÔÇô experience is priceless. When those who have only theories and some academic qualifications to commend them often have the loudest voices and may command the attention of the decision makers, the results are usually less than successful over the long haul.

Again, in my opinion, solidly identifying and agreeing upon what will constitute success, being committed to the long haul, ‘to staying the course’, ‘to running the race to the end’ with funding and by requiring demonstrated, verifiable experience of the helpers chosen to facilitate behavior change plus the consistent enforcement of Government law and policy will be required to help persons change their behavior in ways that will slow and eventually defeat the HIV enemy. Also required would be Government action against business entities whose products, methods of promotion, and advertising encourage negative behavior such as Breweries and Tobacco Manufacturers and distributors.
Alcohol is an addictive drug as is nicotine. Alcohol use is a major factor causing the continued march of the pandemic HIV destruction.

It is helpful to remember that generating lasting behavior change requires motivation to change generated by the pain of consequences, changing deeply ingrained attitudes and beliefs about self and others, about emotions, and about personal, family, and tribal cultural values and perceptions, etc. all of which can result in significant behavior change.
Time takes time but we have run out of time.

Jim McDonald


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