KHOPOTSO: Drawing a rather coy smile from Dr Nomonde Xundu, Chief Director for the HIV/AIDS, TB and STIs cluster in the national Department of Health, the question seems like it requires a whole lot of strength and courage to answer.
Dr NOMONDE XUNDU: I’m actually working on my optimism, Khopotso. We have the same results out of trials.
KHOPOTSO: Staying optimistic in the face of failure after failure of scientific trials aimed at finding new forms of HIV prevention may be hard. First there was the failure of the nonoxynol-9 microbicide in the 1990s; another female-controlled method, the diaphragm, also proved non-effective; and recently, a second microbicide trial flop conducted in Nigeria using a cellulose-sulphate based compound failed. Last year it was announced that the second ever vaccine candidate to reach the final stage of research, in a popular study dubbed ‘Phambili’, was also not effective. This year kicked off with news of yet another failure on the microbicide front. Carraguard, a sea-weed based product, was not an effective barrier. This was closely followed by the announcement of a failed trial investigating whether medicine known as Acyclovir can prevent HIV infection among people with herpes, an infection in the genital tract.
Dr NOMONDE XUNDU: The lesson that I’m getting out of these things is that it is the long haul approach to finding solutions’¦ It’s in the nature of science. You find some of it encouraging (and) some of it disappointing.
KHOPOTSO: Xundu added that when scientists embark on a scientific trial, what they are doing is studying the unknown and hoping to find answers. But in research many such efforts could prove disappointing for many years before a useful answer could be found. Scientists always say that ‘it took 47 years to find an effective polio vaccine from the time when the disease was first identified’. It’s also certain that it will take very long before scientists discover a break-through against HIV infection. HIV has been around for more than two decades and the world is still searching for an effective protective vaccine. But where science is struggling, there is something that can be done at a personal and social level to protect many from harm. Gauteng Premier, Mbhazima Shilowa, put it well in his recent challenge to the province’s AIDS committee.
MBHAZIMA SHILOWA: If we’re going to really turn the tide’¦ one of the things we’ve got to do is to look at what are we going to do to ensure that all of us change our behaviour’¦?
KHOPOTSO: Shilowa was making an appeal to the morals of individuals.
MBHAZIMA SHILOWA: It means if you’re negative, you will try and ensure that you stay negative; that if you’re positive, you will try and ensure that you don’t infect someone else; that if you’re positive, you will try and ensure that you do nothing that will ensure re-infection.
KHOPOTSO: Behaviour change is something personal. It has a lot to do with changing certain things about how we live our lives.
MBHAZIMA SHILOWA: Some of us go out, really drink beyond what we should do, we take drugs, and thereafter, we are happy, we are amorous, we are friendly, we’re now more than generous with ourselves ‘ and I’m talking both men and women’¦ We need to be able to understand that it is those kinds of things that we need to be able to think about.
KHOPOTSO: Scientists concede that this is the only method available to prevent the spread of the HIV epidemic. Even though its appropriateness is being questioned in certain settings of the world, the strategy includes the long-held interventions encompassed in the global ABC campaign urging people to value virginity or to abstain from sex, to be faithful to their partner and to use condoms correctly and regularly. Prof. Lynn Morris of the National Institute for Communicable Diseases, in eastern Johannesburg, is one of the bright minds involved in HIV vaccines research.
Prof. LYNN MORRIS: Really from a public health point of view we’re finding it very difficult, actually, to intervene and stop the spread of this virus. Of course, there are other ways for people to protect themselves ‘ obviously, behaviour change (and) condoms. And that’s what we’ve got to press home to people, that they need to be adopting those kinds of practices.
KHOPOTSO: It’s important to stress the point because changing behaviour can be the power that many people have to safeguard themselves against HIV infection.
MBHAZIMA SHILOWA: What is important is to keep remembering that the decisions (that) we take as individuals will ultimately determine whether we achieve the goal of an HIV-free generation. When all the information has been provided, it is an individual’s decision not to have sex, to be loyal to one partner or to use a condom. These are decisions that each and every one of us has to take.
KHOPOTSO: However, with the many social ills which bedevil South Africa, behaviour change is not only about changing one’s practices. For some, practices are influenced by many other factors such as violence against women and children, poverty and a lack of education. Behaviour change is also about transforming a whole nation. That’s what we will look at in our next ‘Living with AIDS’ feature.