The short advertisements first appeared on Guyanese television stations a few weeks before the event. "Teasers," they're called. In these brief TV spots, an attractive girl and a handsome boy pass each other on the street. They eye each other appreciatively. "Mmmm," thinks the girl, "he has a 'ready body.'"

She looks over her shoulder to admire the boy further and finds that he is looking back at her. Both smile. The girl frowns. "But is it really ready?" she wonders to herself.

Then words come up on the screen: Do you have questions? Visit the Main Street Fair on August 28, 2000.

Next posters advertising an "Operation Ready Body" event appeared around Georgetown, the capital of the South American nation of Guyana. What was it? No one knew for sure. Because the ads and posters used the popular slang phrase for a good-looking, sexy or well-dressed person, some thought Operation Ready Body might be a beauty pageant, or even a wet T-shirt contest.

Their curiosity -- and the driving dance music blaring from enormous speakers -- drew hundreds of young people to Georgetown's Main Street August 28. What they found there was a street fair, with booths lining a central block in the capital's main thoroughfare and "Operation Ready Body" banners fluttering overhead.

Far from being disappointed, the young people stayed to enjoy the music spun by disc jockeys and the performances by theater and youth groups. Many stopped at the booths to pick up information about how to take care of their bodies and, in particular, how to protect themselves from sexually transmitted infections (STIs), including HIV. Some pocketed the free condoms that were available at the booths.

As they watched a performance on the stage, one group of young people pronounced the fair, which marked the official launching of the Guyana HIV/AIDS/STI Youth Project, a "brilliant initiative."

The Threat of HIV

When Dr. Carol Becker became director of the United States Agency for International Development (USAID) mission in Guyana in 1998, the agency did not support any health projects in the country. But Dr. Becker, who had served in USAID missions in Asia and Africa, soon recognized that HIV/AIDS was a serious threat to health and development in Guyana.

The proportion of people testing HIV-positive at a given time in surveys among various groups suggests that Guyana's HIV/AIDS epidemic has already moved from those at greatest risk to the rest of the population. For example, 7 percent of women tested for the virus in a 1995 survey at antenatal clinics in Georgetown were HIV-positive.

One prevalence survey found that 45 percent of the sex workers tested in Georgetown -- where one out of four Guyanese live -- were HIV-positive.

Three to five percent of Guyana's population of 800,000 are believed to be infected with HIV. Among urban, sexually active adults and young people, the level of infection could be much higher.

Most reported AIDS cases are in adults ages 19 to 35, with the greatest concentration among those 25 to 35 years old. Although more cases have been reported among men, the trend in the 1990s was toward an equal number of male and female AIDS cases.

Armed with these alarming statistics and a report documenting limited efforts against HIV and other STIs, Dr. Becker requested additional funds from USAID headquarters to support a "special objective" for HIV/AIDS prevention in Guyana. The amount approved was up to US$ 1.1 million over five years, of which $200,000 was granted for a pilot project in the first year.

Pooling Talents

Dr. Becker asked Family Health International's Implementing AIDS Prevention and Care (IMPACT) Project, which is funded by USAID, for assistance in designing the project and providing technical support. Following further consultation with Guyana's Ministry of Health (MOH), USAID decided to support HIV prevention activities by six nongovernmental organizations (NGOs) from three urban areas. A governmental organization, the Regional AIDS Committee 10 (RAC 10), also expressed interest in collaborating with the NGOs. These groups would work in alliance with the National AIDS Programme Secretariat (NAPS) and the local representatives of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United States Peace Corps.

"With limited funds, it was thought that developing a design that allowed all of the NGOs to work together seemed the most practical approach," explained Carol Larivee, a senior technical officer for the IMPACT Project.

Each of the six NGOs in the Guyana HIV/AIDS/STI Youth Project had worked with youth or in HIV/AIDS prevention, and each brought special skills to the project. Artistes in Direct Support educates people about HIV/AIDS through drama and dance. Comforting Hearts provides care and support to people living with HIV/AIDS. The Guyana Responsible Parenthood Association (GRPA) is the country's main source of family planning and sexual and reproductive health services. Lifeline Counselling Services was established to provide pre- and post-HIV-test and support counseling, but also runs HIV/AIDS education and training programs. Another group that has broadened its mandate to include HIV prevention education, the Volunteer Youth Corps, was originally formed to offer emotional support to all patients in the Georgetown Public Hospital. Youth Challenge Guyana is the local chapter of Youth Challenge International, which sponsors young volunteers to undertake development work in countries around the world.

Dr. Becker recognized the efforts of each of these NGOs to respond to the epidemic. "But while they were all working towards the same goal, each was operating in isolation," she said. "There was the need to pool their talents, and we hoped that the HIV/AIDS/STI project would act as a catalyst."

Catching the Young

The five-year project began with a design workshop in May 2000 that brought together people from all the organizations involved in the Guyana HIV/AIDS/STI Youth Project. It was organized by the Steering Committee, with representatives from the NGOs, RAC-10, NAPS, USAID, FHI, UNAIDS and the Genito-Urinary Medicine (GUM) Clinic, that helps direct project strategies and activities.

The project plan calls for design workshops at the beginning of each of the three phases of the one-year pilot project to ensure that what is learned during one phase is used to improve interventions and strategies for the next.

During the first phase of the project, the NGOs and RAC-10 would assess young people's need for HIV/AIDS and STI prevention education and services and begin to stimulate a dialogue among youth on HIV/STI risk and risk behaviors. The project aims to reach young people who are not yet sexually active as well as those who are. Lifeline Counselling Services Chairman Dereck Springer explains that defining youth as those 8 to 25 years old "will ensure that we catch the young."

Within that broad age range, the target audiences of young people identified for the project fall into three different groups: "limers," as Guyanese youth who hang out on the street are called, minibus drivers and conductors, and young people in organized groups.

Participants in the first design workshop met in three different groups to develop more complete profiles of the target audiences. Limers, they agreed, like to "hang out" at creek and pool parties, on the sea wall, and at fast food joints and minibus stops. Sex is seen as entertainment. Some limers use drugs and alcohol, have many sex partners, and will have sex in exchange for favors or material items.

Limers and other youth look up to the young men responsible for Guyana's foremost form of public transportation. These drivers and conductors of 12- to 15-seat minibuses are perceived as being macho and "super cool," with lots of spare cash. Workshop participants said that when a minibus driver or conductor becomes infected with an STI for the first time, his friends call it "getting your first stripe." HIV is known as "the Major General," or "the Big Truck."

Workshop participants noted that young people in organizations are a different group from the other two. They are more disciplined and have goals related to their group activities, whether they be athletics or community service. However, they also "lime," or hang out, on occasion, and some are sexually active. They may be misinformed about HIV and STIs and think that they are safe if they have sex only with people in their own groups.

Being "Ready"

Workshop participants also divided into groups to begin developing strategies for communicating with members of the three target audiences. It was during this exercise that the theme and slogan "Ready Body -- Is It Really Ready?" was born.

The group working on a communication strategy for limers turned to a phrase Guyanese youth have adopted from the dub, rap and reggae music they love: "ready body." Members of the project's Communications Working Group seized on the idea, pretested it with youth from the target audiences, and refined it.

"Ready body is something youth use in Guyana to say it's looking good," explained Desiree Edghill-Adams, a member of the project's Steering Committee and a co-founder of Artistes in Direct Support. "A ready body is cool, dresses well, looks sexy. The main idea was to grab their attention, which we did."

But the project also takes this theme to another level by asking, "Is it really ready?" This question encourages young people to challenge false assumptions about their invulnerability to disease and to assess their risk of STIs and other health threats. Project outreach workers and peer educators will help guide young people through this process and provide the information and referrals to "youth-friendly" services that youth need to become or stay healthy.

Originally the plan was to use the ready body theme only for the first phase of the project. "We were supposed to change the theme, but we haven't because 'ready body' is in the air," said Edghill-Adams. "It has been so popular, we don't want to move away from it just yet."

Youth at Risk

The plan developed at the May workshop called for efforts to get young people's attention, culminating in three street fairs in Georgetown, New Amsterdam and Linden at the end of the summer, as well as an assessment of HIV/AIDS and STI prevention needs among the targeted youth.

The Steering Committee hired CESRA Technical Support, a local firm, to develop survey questionnaires and other assessment tools, train NGO members in data collection, and analyze the data. The NGOs worked together to conduct a rapid assessment that included a survey, interviews with health workers and community leaders, and focus group discussions and more informal discussions ("rap sessions") with members of the target audiences.

The thick assessment report paints a grim picture of the risks facing these youth. More than 60 percent are sexually active, and the majority do not use condoms consistently.

Almost half of the youth surveyed said they worried about contracting an STI, indicating that they are probably having unprotected sex with one or more partners.

Perceptions of personal risk of contracting HIV varied among the different groups. Thirty-percent of the minibus drivers and conductors felt that they were greatly at risk of HIV infection, compared to 19 percent of limers and 9 percent of youth in organized groups.

The survey revealed widespread misconceptions about the transmission and prevention of HIV, which were echoed by participants in focus group discussions. Some young people, for example, thought that God would protect them from becoming infected with HIV, regardless of their sexual behavior. Others believed that HIV and other STIs could be contracted from toilet seats, perspiration, sneezing and fingernails.

Prevailing myths about condom use also surfaced during the focus group discussions. Many participants said they don't like to use condoms because they rob sex of its pleasure. Others said using a condom is a waste of time because they don't work.

Some young women said that they had agreed to sex without a condom because they thought they would be raped if they refused. Violence was seen as a threat by an alarming proportion of the young people surveyed. Almost 27 percent said they worried about being sexually abused, and half of them worried about physical abuse.

"What the survey has done is to make us aware of how much at risk our young people are of contracting STIs and the factors which put them at risk," LCS Chairman Dereck Springer said.

The Power of Music

The Steering Committee and other project partners started using the assessment results right away at the design workshop for the second phase of the pilot project in September. After reviewing the results and the project's progress, they developed a plan that includes producing communication materials for the project, completing a peer education manual and other training materials, and identifying and training peer educators.

Assessment findings on the judgmental attitudes of many healthcare providers toward young people led to plans for a more detailed study of the available HIV/AIDS and STI services. Youth-friendly services identified through this assessment will be promoted and strengthened during the third phase of the project, when peer educators will begin to spread the word about HIV/STI prevention to their friends and acquaintances.

The assessment also looked at where young people get their information about sexual health and other health issues and their preferred sources of such information. Based on these findings, the assessment report recommends mounting a sustained and aggressive campaign to dispel myths and promote safer behaviors through music, street theater, disc jockeys (DJs) and popular artists.

The NGOs and others working in HIV/STI prevention in Guyana recognize the power of DJs and popular music. The NAPS, for example, had conducted a workshop with DJs to encourage them to educate young people about how to avoid STIs. The GRPA plans to produce rap messages developed by the DJs and disseminate them on cassettes to minibus drivers and conductors.

Most young people use minibuses. Some refuse to ride minibuses that are not equipped with the large portable radio and cassette players known as "boom boxes," which are illegal but pervasive.

After the Main Street Fair, taped advertisements were distributed to minibus drivers to advertise the street fairs in the two other project areas, New Amsterdam and Linden. As in Georgetown, DJ music drew young people to these fairs and kept them there. However, it also attracted criticism from some adults who thought the music was too loud and went on too long -- especially in Linden, where the street fair became a street festival, with people dancing into the night.

Young people's reaction to such criticisms may be some indication of the project's success in reaching its audience. At a forum organized by Comforting Hearts head Muriel Sandy, the young people asserted that they would not have attended the New Amsterdam fair if there were no music. Nevertheless, they insisted that the fair provided an opportunity for them to learn about protecting themselves from STIs.

"But this has served as a further learning for all of us," said Kenroy Roach, head of Volunteer Youth Corps, of some of the negative reactions to the street fairs. One lesson, for example, is to start events earlier so that they do not become all-night parties.

Building a Foundation

Julia Rehwinkel, Peace Corps volunteer and Jack-of-all-trades, is the project coordinator. She acts as the liaison between USAID, FHI/IMPACT and the Steering Committee, coordinates project efforts with regional and international groups, and monitors project activities.

From this vantage point, Rehwinkel has seen a rapid evolution of the relationships among the NGOs and the ways they work together. "At the beginning of the project, each NGO would ask me to arrange any assistance that was required, even if it could be provided by another NGO on the project," she said. "All that has now changed. The group has jelled, and they are now more likely to work directly with each other."

Rehwinkel sees the unity engendered by the work of the Steering Committee as one of the pilot project's most important accomplishments, noting that the groundwork has been laid for the NGOs to continue their collaboration after the five-year project ends.

"I think the consolidation of the framework is a measure of success," agreed Larivee. "This framework, as it is strengthened, should allow for more organizations and donors to participate."

The project recently received its first contribution from a donor other than USAID in the $US 44,000 from Japanese Grant Assistance for Grassroots Projects. The grant will be used to purchase much-needed equipment for the NGO centers.

Moving Ahead

In October, the project moved into its second phase. NGO members have begun identifying young people who will be trained as peer educators. The project's Communications Working Group is working with a local consultant to produce a peer education manual and other training materials.

Meanwhile, the NGOs are keeping the Ready Body message in the spotlight. Steering Committee members and project consultants appear frequently on the interview and call-in shows aired by Guyana's 20 TV stations. The combination of many content-hungry TV stations and dynamic, media-savvy promoters has resulted in a great deal of free media coverage for project messages.

The main events of the second phase are the annual Phillip Vanderhyden AIDS walk-a-thons to raise money for HIV/AIDS care and support. Hundreds of Guyanese joined Minister of Health Dr. Henry Jeffrey at the first walk in Georgetown October 29. DJs wrote safer sex (Ready Body) messages that were chanted along the five-kilometer route.

The NGOs were also gearing up for World AIDS Day, held every year on December 1. Comforting Hearts, for example, was organizing a rally in New Amsterdam for secondary school students from throughout the county of Berbice. Members of Artistes in Direct Support were working on their annual "The Flame and the Ribbon" program, which drew inspiration from this year's World AIDS Day theme, "Men Make a Difference." Edghill-Adams, who wrote a play for the program, says it opens with a disco scene and the song, "Let's Hear it for the Boys."

Carrying On

"The Guyana Youth HIV/AIDS/STI Project is off to an excellent start, but it faces some tough challenges," Dr. Becker noted. These include a dearth of accessible condom outlets, lack of confidentiality in HIV counseling and testing, and little involvement of the Indo-Guyanese population in HIV/STI prevention efforts.

HIV/AIDS is perceived as a problem of the Afro-Guyanese, explains Edghill-Adams. "They think it's a black thing."

This may be because the majority of those who rely on the public health system in urban areas are Afro-Guyanese. Urban-based Indo-Guyanese tend to use the private hospitals and clinics, which do not report on HIV statistics.

Nationwide, the Indo-Guyanese account for 51 percent of population, so it is particularly important for the project to engage them and their religious leaders. The Communications Working Group has made a point of using young people of all ethnic backgrounds in its materials. In the teaser for the Georgetown fair, for example, the girl was Indo-Guyanese and the boy was Afro-Guyanese.

Another major challenge is identifying STI, HIV and other health services that the project can recommend to youth. Without additional funding from other sources, the project will be able to offer only limited training in STI diagnosis and treatment to selected health personnel. Yet the need for high-quality, accessible reproductive health services for youth is great.

The assessment found that more than half of the young people surveyed had sought medical care at public clinics. For STIs, however, two out of three said they would go to a private doctor. Few services, public or private, make youth feel welcome.

Only 18 percent of survey respondents had been tested for HIV. All said that such services should be confidential -- a major problem in Guyana, where the stigma associated with HIV is strong.

People who test HIV-positive have few places to turn in Guyana. A handful of church groups provide community-based care. Doctors and nurses are often reluctant or unsure of how to treat people living with HIV/AIDS.

Edghill-Adams learned this firsthand when Keith André Sobryan, chairman of the National AIDS Committee and dramatist extraordinaire, fell ill. His doctor was out of town, and she could not find another physician who would come to Sobryan's house. Sobryan died in a private hospital where his friends took over his daily care because the nurses were afraid to tend to him.

All those involved in the response to HIV/AIDS in Guyana will miss Sobryan, whose candor, talent and insights contributed so much to the fledgling project during its first five months.

While many involved in the project are grieving this loss, they are also inspired to continue the work Sobryan did with such passion and flair. As Edghill-Adams explained, "I am more determined than ever to carry on the legacy he has started."

-- Cheryl Springer

Cheryl Springer, a Guyanese journalist, is chief sub-editor of the Stabroek News in Georgetown, Guyana.