FHI - Barriers to HIV Prevention

Barriers to HIV Prevention

Barriers to Behavior Change

Despite the efforts of national governments and NGOs, southern African populations have been slow to adopt safer sex practices. The reasons for this lack of success in changing behavior are complex, but some of the contributing factors include male migration, conservative cultures, gender and the prevalence of violence.

Mining and agriculture make up a substantial part of the economies of South Africa, Zimbabwe and Zambia. These industries rely heavily on migrant labor from within the three countries, as well as from other neighboring countries. It has been well established that men living away from their families and their home communities are more likely to have multiple sex partners.

Among migrant workers, one is often confronted with a certain fatalism about contracting AIDS. It is considered a distant threat compared to the dangers they face in some of their jobs or in neighborhoods where death from gang violence is a more immediate concern.

In many of the southern African cultures, women are conditioned to be submissive to their male partners and to give them sex when they require it, regardless of whether a condom is used. This is particularly true for the partners of returning migrant laborers. These women are not empowered to demand condom use from their partners, who are most likely at risk of HIV and others STIs. Also, because educational and economic opportunities for women are more limited, more women resort to commercial sex work for their economic survival.

On the other hand, most southern African cultures are pronatalist and very conservative about sex, which discourages open discussion about sex and sexuality. In this context, changing sexual practices is particularly difficult.

Access to Condoms

While behavior change is the most significant part of the problem in preventing HIV transmission, basic condom availability is still an issue along some parts of the transport corridor. The national departments of health procure millions of condoms, but distribution of these condoms to local health departments is extremely inefficient, leading to large over-stocks in some areas and shortages in others. Since distribution points for the condoms are limited to the public health infrastructure, it is particularly difficult for the mobile high-risk-behavior groups to obtain them. Condom social marketing could fill that gap by making condoms available through both formal and informal outlets accessible to the target populations along the transport corridor. For example, 24-hour service stations are the most obvious outlets, since many provide secure overnight truck stops where high-risk sex is often practiced.

During an initial site visit, representatives of the Society of Family Health/South Africa found that traders were generally willing to stock condoms. Some were selling the free supplies that were provided irregularly by the departments of health. Others, although reporting demand, failed to stock any condoms at all, but were keen to do so when supplies were offered. It is clear that both sex workers and truckers congregate at certain key sites and truck stops where there is a great need for condoms and interpersonal interventions advocating their use.

Other issues must be overcome in order to improve condom access. In South Africa, for example, getting product listings for certain retailers -- particularly the petrol station chains -- has proved complex. Some retailers perceive that there is still a stigma attached to stocking condoms. And in Zimbabwe there are very few outlets at the border posts; penetration of these sites cannot be gained via mass media alone and will require interpersonal communication.

See Also:

Barriers to HIV Prevention