We Have Changed

Reading the excellent new book on HIV/AIDS in Africa by Helen Epstein "The Invisible Cure" you are reminded of the power of frank talk. While President Museveni of Uganda deserves much credit for the drop in HIV rates in that country through the promotion of both an open national discussion of HIV/AIDS and promotion of the 'ABCs' (despite an overemphasis on the 'A'), the real story is the openness of the Ugandan people. One of the key points of Epstein's narrative is how Ugandans, from the early days of the AIDS crisis, were able to discuss the problem. This may be in part from the cohesive nature of Ugandan society, one that, despite years of brutal dictatorship under Idi Amin, survived into modern times. This is in stark contrast to other countries, particularly South Africa, where society and families were uprooted by both apartheid and economic forces (especially in regard to the mining industry). In a less cohesive, more fragmented society, such open talk was rare. Add to this the unfortunate denial of all things HIV/AIDS related (from the science to prevention to treatment) by President Mbeki, and a time bomb exploded with tragic effect.
Another interesting thread in the book is the story of loveLife, a nationwide media campaign meant to promote healthy lifestyles for the youth of South Africa. While the program enjoyed some popularity, often employing the methods of Western glitzy advertising and American self-help gurus, HIV/AIDS prevention, the nominal goal of the campaign, was rarely discussed in a frank manner. Donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria lost interest as well, and it is still not clear how positive an impact loveLife has had in South Africa. What is clear is that real discussions about HIV/AIDS are an effective preventative measure. Media projects that deal with the reality of HIV/AIDS, rather than a preconceived notion of the facts, are more likely to add to this open discussion. This is true of documentary films as well.
And what of an open discussion when it comes to distributing funding for health care? Much of the truth in terms of absorptive capacity and sustainability is on the ground, in places like the clinics and hospitals of Zambia and elsewhere. There is nothing inherently wrong with grand designs for improving the life of millions suffering from HIV/AIDS and other plagues. In fact, such goals are an admirable change from the extremes of the past, either outright neglect or funding with ulterior motives of a geopolitical bent. But an open discussion with those who know best, those in individual countries each with their own culture and unique set of hurdles, is a good place to start.