Obstacles and challenges to sexual behaviour change

This chapter discusses three of the general issues that have emerged from the continuing discussion on AIDS in sub-Saharan Africa and Asia: whether African and Asian countries can share experiences in their responses to the epidemic; the observed obstacles or resistance to sexual behaviour change; and the concept of community as used in intervention programs. The aim is to explore these issues in the context of the varying patterns of spread and responses to the epidemic. Responses to HIV and AIDS: can Asia and Africa share experiences?1 The outbreak of AIDS has challenged some of the perceptions about our own societies. Until recently, there was an idealized picture of African society with built-in social morality and interfamilial as well as intrafamilial support. Similarly, in India, the outbreak of the epidemic has shattered the belief that ‘India’s deep-seated family traditions, social conservatism and spirituality would protect it from the ravages of the global AIDS epidemic’ (McDonald 1992:28). The pattern of infection and the reactions to the epidemic have reinforced the universality of human behaviour. Responses to AIDS in Africa and Asia seem to follow a similar pattern. There has been the initial denial followed by the blaming of foreigners. The next stage, which now seems to appear in the literature and to be reflected in the types of intervention, is the identification and the targeting of ‘risk groups’: sex workers, long-distance truck drivers, intravenous drug users (see Marck this volume Chapter 8; Singh and Malaviya 1994; Podhisita et al. 1996; Mukodzani, Mupembo and Marck 1999; Orubuloye and Oguntimehin 1999). The third stage is the recognition of cross-over of the virus from the risk groups to the general population. In the final stage, the epidemic becomes a major public health problem as is happening in parts of Eastern and Southern Africa. While some countries in sub-Saharan Africa have gone through the full cycle with disastrous consequences, other areas are in the second or third phases (see Figure 1). Asian countries are in a position to learn from sub-Saharan Africa. One thing to be learnt is that concentrating on risk groups diverts attention from aspects such as the infection of partners by clients of people in the risk category. Secondly, what is important is not so much the number of sexual partners, but the number of risky exposures in any sexual encounter. Although one of the initial responses to the epidemic in Southeast Asia was to identify and target risk groups, some countries have established public education campaigns to avert some of the extreme negative effects of the epidemic. For instance, the high mortality in 1 See Caldwell and Caldwell (1988) for a similar discussion on the applicability of the Asian model of family planning delivery to Africa. 236 K. Awusabo-Asare