prevented HIV. Not surprisingly, with free condoms available, the proportion of women always using them increased from 16 to 60 per cent (though the proportion
'never' using condoms stayed the same). But more significantly,
during the trial, the average number of sex partners among the women went
down from 4.1 to 1.7 a day.
Had they managed to find alternative sources of income? Or did the health
education the women received itself help them to be more assertive and
resourceful?
The scaling-up challenge
Scaling-up such pilot studies so that, for instance, HIV treatment can
be provided for 100 per cent of those who need it in Africa rather than
the current 0.1 per cent will be the biggest challenge over the next two
years.
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Ground-level prevention projects based in community clinics
already offer a model. It need not take a whole new infrastructure to
add in treatments.
Chilando Mukuka-Chilaika from eastern Zambia, for instance, introduced
the Thandizani community-based project. This has expanded from a pilot
project in 28 villages to a network now working in over 1,000, serving
a quarter of a million people.
In the Thandizani project each village has its 'HIV prevention club' to
discuss sex, relationships and condoms. These are overwhelmingly run by
the local women, with resultant huge changes in relationships between
the sexes.
Thandizani's ready-made structure provides an integral food and famine
relief provision to this hard-hit area. And every local authority has
been roped in to support the scheme; from village chiefs to church leaders
and the established health boards. (Chiefs are encouraged to test publicly
for HIV - setting an example - but are encouraged not to reveal their
status - so they don't get stigmatised). In
this way learning about Aids becomes a cultural norm rather than a fringe activity.
