The continent hasn't done everything right, but America should take note of these strategies.
(The Root) -- At the International AIDS Conference in Washington, D.C., this week, much of the focus has been on Africa. And rightly so: It has been hit hardest by the disease. In Africa, 23 million people are living with the virus, or 68 percent of the world's HIV-positive population. In some African countries as many as one out of every four people are living with the virus. For many, getting infected seems inevitable.
Without a doubt Africa needs us -- our love, support and dollars. But too often we approach Africans only as sick, helpless and in need of "saving." Think of the People magazine photo op: [fill in the name of a well-meaning celebrity] surrounded by a sea of brown faces.
But what if we flipped the switch and looked at what we can learn from the continent that's been sitting squarely in the eye of the HIV/AIDS storm for decades?
In the face of huge obstacles and few resources, Africa has shone with collaborative, creative, inexpensive solutions to the HIV/AIDS crisis. Africa hasn't done everything right. Some governments have mismanaged funds intended for prevention and treatment. And many areas of the continent have ignored the epidemic among gay and bisexual men -- particularly the nearly 40 countries where homosexuality is illegal.
Still, it's worth looking at how Africans have made a way out of no way, especially in impoverished, rural areas where equipment, medical providers and even running water are scarce. And now's the time: We need solutions on our side of the ocean.
Even as AIDS has become a "manageable" illness in the United States, the disease has grabbed hold of black America, where it continues its stranglehold without a sense of action or urgency from anyone aside from the most aware and devoted. In parts of our country -- the South and Washington, D.C. -- African Americans are getting infected at rates that rival and surpass those of the continent politicians and celebrities have been so desperate to save.
Dázon Dixon Diallo has done HIV/AIDS work in both the U.S. and South Africa and points to the African sense of self-reliance and community that we too often lack here. "There it's neighbors taking care of neighbors because they know each other, because they are a community," says Dixon Diallo, founder and president of Atlanta's SisterLove. "Here it's either the AIDS program takes care of you or you're on your own. We need to recapture that sense of caring for each other from our African brothers and sisters."
I agree. When I traveled to Ethiopia and more recently Zambia, I was struck by the many ways Africans beat back the disease with a spirit of hope, collectivism and action frequently missing in this country. Thanks to recent scientific advances, drug therapy will play an increasing role in both HIV prevention and treatment.
But medication alone won't stop the epidemic. It must be coupled with the kind of community-focused, hands-on prevention and care common in Africa. Here are five lessons from countries like Zambia and Ethiopia about fighting the epidemic:
Train Regular People to Deliver Services and Care
Zambia has just over 1,200 physicians serving a population of 13 million, according to 2006 data from the World Health Organization. To help fill the enormous gap, the country has recruited and trained thousands of community-health workers to provide services, including more than 4,500 adherence-support workers who earn a monthly allowance to help people living with HIV stay on their medication.
Ethiopia is a leader in this area. For almost a decade, an army of some 40,000 health-extension workers, mainly young women, go door to door, traveling on foot or bicycle between villages offering reproductive health services, education and support. They receive a year of training and a small salary.
In the face of our own shortage of trained health care practitioners, particularly in the South, we should look at how to adopt a similar strategy.
Fully Engage the Faith-Based Community to Provide Appropriate, Nonjudgmental HIV Services
In the U.S., the black church has come a long way in recognizing HIV/AIDS, thanks to the work of organizations like the Balm in Gilead and progressive individual pastors and congregations. But it has a way to go.
In Zambia, religious institutions and leaders are deeply involved in the AIDS crisis. In fact, Churches Health Association of Zambia (CHAZ) is the country's second-largest health care provider. It supports hospitals, clinics, HIV/AIDS organizations and groups that care for children orphaned by the disease. The government and HIV groups have reached out to traditional healers -- some who believe HIV is caused by bad spirits -- to work together to battle HIV/AIDS.
And unlike far too many faith-based organizations here, the church establishment in Zambia has largely moved past judgment and beyond abstinence-only messages. "When HIV came here, the church took on the role of providing care, particularly in rural areas," says Dr. Clement Chela, director general of the National AIDS Council, a government agency. In fact, the chairman of NAC's board is a senior church pastor.
"Early on, some were obstructive, especially on condoms. But the church has come a long way in providing all kinds of reproductive health services, HIV support, counseling and treatment -- including condoms."
Imagine if congregations all over our country, especially those in poor black communities and including rich mega-churches, took on HIV/AIDS as a cause -- with compassion instead of judgment.
Include Men in HIV/AIDS Prevention
In Zambia, HIV is more common in women than in men, and most women are infected by a husband or boyfriend in the context of a "stable" relationship. To reach men, last year Zambia launched a mass-media campaign called Brothers for Life. Its messages are blunt, targeted and to the point: "A man takes responsibility through his thoughts and actions. Be a man for life," and "Be a man who is not afraid to know his HIV status."
In the U.S., women account for one in four people living with HIV, and the vast majority are infected through sex with a man, often a spouse or a boyfriend. Nearly 70 percent are black. Women are urged to protect themselves and to insist that their partner use a condom every time. But what about men? They're the ones who wear the condoms. Where is the full-scale HIV-prevention campaign for men who have sex with women who are asking them to be honest and faithful and use condoms every time?
Think Way Outside the Box
One size doesn't fit all in terms of HIV prevention. To discourage women in Zambia's Mumbwa district from delivering their babies at home, health care providers enlisted the help of Senior Chief Shakumbila. (At a hospital or clinic, a pregnant woman who has HIV can receive medication to prevent her baby from becoming infected.) The chief created a rule that if a pregnant woman fails to deliver her baby in a medical setting, the family must pay the price of three goats.
"When you are dealing with human beings, you have to be strict," says Shakumbila, who governs 486 villages. "These men don't want to be punished, so they take their wives to the hospital. This has helped very much against HIV/AIDS."
This is a creative solution that respects the way of life of a community while pushing it toward an effective, 21st-century method to reduce HIV transmission.
Fight HIV, Not People With HIV
In our country, HIV/AIDS stigma is most intense in small towns, particularly in the South. Growing numbers of people living with HIV/AIDS in places like rural Mississippi and Alabama hide their status, terrified of being ostracized. In Zambia, while stigma exists, those in the field say that rural areas approach HIV with less judgment than compassion.
"Everyone knows someone with the disease in these rural villages, so there's less shame," says Yoram Siame, advocacy and public relations manager for CHAZ. "And there's also a sense of community-ness, of caring for each other in rural areas."
Angela Maseka, a no-nonsense nurse-midwife at the Maramba Clinic in Livingstone, Zambia, treats and counsels HIV-positive women -- most of whom are pregnant -- who come from poor, sometimes remote areas where HIV/AIDS is widespread. "HIV is not an illness," says Maseka. "It is just a virus that affects some people. What's the shame?"
No one should argue with that.
Writer Linda Villarosa traveled to Zambia earlier this month with a delegation of journalists sponsored by the Global Fund to Fight AIDS, Tuberculosis and Malaria.