Newsday - December 27, 1988
Laurie Garrett

Despite the expenditure of millions of dollars around the world to teach people about the dangers of AIDS, few education efforts have been assessed to determine their effectiveness. But of those that have been analyzed, most have been judged failures, experts say.

"We are gathered here by a common belief that the epidemic can be controlled by changing human behavior," Jonathan Mann, director of the World Health Organization's AIDS program, recently told a conference in Ixtapa, Mexico, of public health officials from developing nations. But, he added, "Biomedical science against AIDS has reached a certain halting point. In order now to succeed new tools and concepts must be found. We wonder now if the same may not be true of education."

Virtually no public health efforts to educate people about how to avoid AIDS have actually succeeded in altering the sexual behavior that puts people at risk, Mann said.

A Gallup Poll conducted earlier this year in 35 nations showed that 96.5 percent of those surveyed had heard of AIDS. But much of the information that has been distributed has been misunderstood, often in dangerous ways. For example, Nigerian television, radio and newspapers were saturated for a month with AIDS information. A Nigerian researcher, Dr. F. Soyinka, in an interview with Newsday, said residents of the capital of Lagos were surveyed afterward and that "eighty-five percent believe AIDS is a disease of the white man. They believe it can only be gotten if you have sex with a white man."

There are misunderstandings even in the industrialized world. Researchers from the U.S. Centers for Disease Control who surveyed high school students in seven American cities found that most had heard of AIDS, but nearly all of the students thought the disease was spread by donating blood, through insect bites or from toilet seats.

Around the world there are examples of groups denying the possibility that AIDS could affect their lives, usually by pointing the finger at another population group and concluding "they" are the ones at risk, not "we," experts said. When the first cases appeared in India, African students were rounded up and deported, their belongings destroyed, in the mistaken belief that they were the carriers of the new disease. In fact, all the early cases in that country were either westerners or Indians.

There have also been some serious mistakes. Mexican psychologist Luisa Rossi of the Center for AIDS Information in Mexico City discovered that teens in Mexico City had misinterpreted warnings about "casual contact" and "casual sex." A government education campaign warned teens to avoid "casual sex," but reassured them that AIDS could not be transmitted by "casual contact." Among Mexican teenagers, Rossi found, the terms meant the same - sexual relationships without commitment - and most chose to conclude that such liaisons were safe.

There are a variety of impediments to the educational campaigns, according to William Smith of the Washington-based Academy for Education Development, an independent research institute, including:

People doubt they can be infected, often saying, "It just won't happen to me." Thus, most people conclude that AIDS isn't very important.

Condoms, the solution offered by public health experts, aren't an attractive option for most of the world's population. Studies show that only two cultures (Japanese heterosexual and, recently, gay American) have found condom use erotic and attractive, while most of the world's cultures reject use of the prophylactics.

Researchers from places as diverse as Mozambique and Canada have reached the same conclusions in the past year.

Only within the gay community in industrialized countries has education seemed to have had an impact. And even there experts question whether the slight decline in new cases of AIDS is due to education or to fear, as more men watch their friends and lovers die.

Manuel Carballo, head of the World Health Organization's AIDS education effort, said in an interview that the epidemic is forcing researchers to evaluate the effectiveness of a whole battery of standard public health weapons, in hopes that something besides a chilling death toll can motivate individuals to protect themselves from the virus.

Another frustration, said Carballo, is that if some approaches have been working, there is no way for the worldwide public health community to know. "Very few education programs are set up with evaluation in mind," he said.

"I think we have got to do a lot on faith right now," Carballo said. "We must evaluate, but nothing should stop simply for the sake of evaluation. The nature of the problem calls for us to do all we can now. Even on faith. And we're going to have to live with that for a while."

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