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Speeding HIV's Deadly Spread

Faruk Maunge, 36, a high school counselor in Francistown, Botswana, points out one of several friends who died of complications from AIDS.
Faruk Maunge, 36, a high school counselor in Francistown, Botswana, points out one of several friends who died of complications from AIDS. (By Craig Timberg -- The Washington Post)

Maunge said he once was reckless, too, having sex with three women in a week, sometimes without condoms. But after watching the disease kill more than 20 of his friends, he settled down with a new girlfriend and stayed faithful, he said.

"Praise God, I've been lucky," Maunge said. "It's like you have 10 bullets going through you and none hits you."

The Missing Message

On a hospital wall here, not far from the AIDS clinic that Khumalo visited with his friend, the painted image of a condom shimmers like a comic-book superhero. Giant, colorful block letters declare, "CONDOMISE AND STAY ALIVE!!"

In cramped black script below, it adds, "Abstain first."

Yet rarely seen among Botswana's AIDS prevention messages is one that has worked in other African countries: Multiple sex partners kill. Dubbed "Zero Grazing" by Ugandan President Yoweri Museveni, this approach dominated in East Africa, where several countries curbed HIV rates.

Fidelity campaigns never caught on in Botswana. Instead, the country focused on remedies favored by Western AIDS experts schooled in the epidemics of America's gay community or Thailand's brothels, where condom use became so routine it slowed the spread of HIV.

These experts brought not just ideas but money, and soon billboards in Botswana touted condoms. Schoolchildren sang about them. Cadres of young women demonstrated how to roll them on. The anti-AIDS partnership between the Bill & Melinda Gates Foundation and drugmaker Merck budgeted $13.5 million for condom promotion -- 25 times the amount dedicated to curbing dangerous sexual behavior.

But soaring rates of condom use have not brought down high HIV rates. Instead, they rose together, until both were among the highest in Africa.

The focus on condoms endured even after the arrival of internationally heralded "ABC" programs, named for their prescription of "Abstain, Be Faithful and Condomize." The middle concept -- fidelity -- often got lost.

The few posters advocating it in Francistown are old and torn; ads for condoms and abstinence are far more prominent. A 2004 government study measured the result: Three-quarters of Batswana surveyed knew that condoms could stop the spread of HIV. Half knew that abstinence would. Yet only one in five knew that fidelity to a single, uninfected partner prevented spreading the disease.


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