International AIDS Society Newsletter, no. 16

IAS
INTERNATIONAL
SOCIETY

* Mystification of sexuality and denial of existence of sexual life among youths and adolescents thus preventing open discussion and
sharing of desires, fears and expectations of
wouldbe sex partners and avoiding to educate
adolescents and youths.
While it is clear that there is no difference in the
frequency of engaging in heterosexual intercourse between populations in the developed
north and in sub-Saharan Africa, it is mainly
the poorer biological and socioeconomic environments in sub-Saharan Africa that facilitate
HIV transmission requiring immediate and
aggressive actions by all members of the society
including politicians, public officers, community leaders and parents.
In this regard it is gratifying to note the available huge research reports on the HIV infection
problem in sub-Saharan Africa often resulting
from collaborative projects between scientists
from the South and North. If we take the United Republic of Tanzania as an example where
AIDS was first described late in 1983 and confirmed by laboratory tests in August 1985; the
country has participated in many bilateral research activities with scientists from Europe
(Sweden, Norway, Germany, the United Kingdom, Denmark, Italy, the Netherlands and the
European Union), the USA, the World Health
Organisation and UNAIDS. However, the
longest and by far the largest bilateral research
activity has been that between Tanzania and
Sweden, in the TANSWED HIV Programme,
which has been there since 15 years back and
has involved 8 - 10 research projects with funding in 2 - 3 year cycles from the Swedish International Development Agency, Department of
Research Cooperation, SAREC. During the 15
years of the project, it has resulted in more than
240 publications in journals, books and at conferences and has contributed immensely to
national and international efforts in AIDS prevention and control. One of the recent achievements has been the successful participation and
completion of the largest multicentre intervention study against mother to child HIV transmission using antiretrovirals (PETRA study)
which was coordinated by the UNAIDS and
where the site in Tanzania was a collaborative
effort with Sweden. The bilateral programme
with Sweden has been between the Muhimbili
University College of Health Sciences in Dar es
Salaam and three institutions in Sweden including the Swedish Institute for Infectious Disease Control, the Karolinska Institute and the
Ume3l University.
Opportunities for networking including the
African series of biennial AIDS/STD conferen
ces have added a lot to the sharing of informa
tion and to understanding of the factors contributing to the increasing HIV infection problem
in the region.
Through such collaborative efforts the following priority actions should be undertaken:
* Break the silence on sexuality and on the magnitude, extent and determinants of HIV infection and STDs in sub-Saharan Africa and utilise the proven intervention measures.
* Develop a consensus to be adopted by governments, political, community and family leadership on the way forward by developing and
enforcing strategic plans for implementation
at all levels to address the major contributory
factors including:
- providing appropriate, client-friendly STD
case management facilities targeting youths and
adolescents,
- reducing unsafe sexual behaviour among
highly mobile populations including commercial sex workers, the military and long distance
truck drivers,
- bringing youths and adolescents on board to
reduce their vulnerability,
- maintaining safe blood transfusion services,
- contributing to poverty reduction including
reducing socioeconomic inequality between
social groups and between men and women,
- promoting acceptance, understanding and
support of persons living with HIV/AIDS as
equal members of the society,
- reducing unprotected sex among men engaging in sex with multiple partners,

- reducing vulnerability of women including
female adolescents and youths in adverse cultural environments.
* Promote and participate in multisectoral and
multilateral research activities towards development of new knowledge and technologies
to prevent and control HIV infection including chemotherapy, vaccines, reliable diagnostics, prophylactic genital microbicides, and
other intervention measures.
From the successful HIV infection preventive
strategies available in the world and in subSaharan Africa it is obvious that there is a clear
way forward. The way forward includes the
impact of educating adolescents and youths to
postpone their engaging in sex. Promotion of
safer sex practices, including the use of condoms and other barrier techniques is another
way forward. Screening of blood donors, prevention of mother-to-child transmission using
antiretrovirals are also important factors, as is
the improvement of delivery practices and
shortening of the breastfeeding period. Equally
important is the correct management of other
STDs by the syndromic approach and increased
HIV counselling and testing for at risk-groups.
HIV infection is indeed preventable and controllable on condition that scientists and the
community leadership including the mass
media, cultural and religious groups as well as
families and individuals develop a consensus on
what to be done and invest energies and enough
resources. The international scientific community and other agencies as well as community
organisations have a lot to gain by continuing
to assist and participate in the AIDS control
efforts in sub-Saharan Africa and in other developing countries.

N