HIV Prevention Fractures Into Local Struggles

Eleventh-graders Demetrius Brand, 16, and Asa Harris, 17, made a video about a football team with an HIV-infected player. "We're trying to show that you shouldn't be scared of AIDS because you can't catch it when somebody touches you," Brand said.

Sophomore Jessica Briggs, 15, said Neely's course filled in some of the blanks that were left after the health education class. "Some of the stuff we learned in here that other people can't tell you is some of the stuff we need to know, and it makes a lot of difference knowing it," she said. "Like how many people in Florence have it, and how close to home it can hit."

But Neely's course is unusual in South Carolina, said Doug Taylor of the Eastern Carolina HIV Prevention Collaboration, one of eight coalitions of community organizations in the state that receive federal prevention funds.

Health education classes often are taught by physical education or home economics teachers who don't always feel comfortable talking about topics such as sex and AIDS, Taylor said. Although a recent survey of North Carolina registered voters found that 96 percent supported school-based education about AIDS and sexually transmitted diseases, only five of the state's 91 school districts have adopted one of the AIDS education curricula certified by the CDC. A few other districts are using portions of one of the curricula in HIV education programs.

Taylor said his agency is trying to convince local school boards that the CDC-certified curricula, which contain explicit information about sex and how to prevent sexually transmitted infections, have been found in studies to reduce teenagers' risk-taking behavior, rather than encouraging promiscuity. But in South Carolina, it's a tough sell. "Some teachers aren't going to feel comfortable putting a condom on their finger in front of students," Taylor conceded. "That's just reality."

The CDC's decision three years ago to give local communities a major role in AIDS prevention presented a huge challenge for state and local health officials and activist groups. In cities such as New York and San Francisco -- longtime "epicenters" of the epidemic -- there were AIDS organizations ready and waiting to take on the job. But in many parts of the country, and particularly in rural areas, federal health officials discovered that no local activist groups existed to apply for the prevention funds. The agency found itself giving grants for grass-roots organizing.

"In many of the communities where HIV is now occurring, particularly in communities of color, one of the issues we've been dealing with at the CDC is that there's not a very well developed community organization infrastructure," said Ronald O. Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention. "It's not like the infrastructure that grew up around white middle-class gay men."

When the South Carolina statewide community planning group began meeting in 1994 to try to set priorities, it was the first time that representatives of some constituencies, such as gay rights groups and African American organizations, had worked together. "A lot of people accused each other of hidden agendas," said Francisco Sy, an associate professor of epidemiology at the University of South Carolina School of Public Health who is the planning group's current co-chairman. "There were times during the first year when I thought the group would not survive."

Another of the planning group's founding members was DiAna DiAna, a Columbia hairdresser who had been one of the first South Carolinians to grasp the potential impact of the AIDS epidemic and to try to do something about it. DiAna was sorting magazines in her beauty shop one day in 1986 and came across an article about a woman who had been infected by her boyfriend. It was a revelation.

"Your clients always tell you all their personal business," DiAna said. "I knew who was sleeping with who already. Some days I'd do the wife and some days I'd do the girlfriend. Just putting two and two together, I said, 'This is going to be a mess.' "

She set up a small AIDS information center in her salon, giving away condoms and brochures. Then she began marketing "safer-sex kits," containing condoms, lubricants, latex squares to be used for protection during oral sex, and other equipment. Next came AIDS prevention programs for teenagers and for women, then a training course for hairdressers, barbers and other business owners on how to provide HIV education for their customers.

Although DiAna still works in her salon, HIV prevention has become a second career. She and a colleague operate a tax-exempt, nonprofit corporation, South Carolina AIDS Education Network. They charge $ 1,000 a day plus expenses to conduct workshops. DiAna had to add a storeroom onto her house to hold the cartons of multicolored condoms, T-shirts, safer sex kits, tote bags and literature. "I really thought it would be over in a couple of years," she said.