San Francisco Chronicle - Wednesday, June 27, 2001
Sabin Russell, Chronicle Medical Writer
United Nations -- The billboard alongside a South African freeway is blunt: "Oral Sex. Talk about it."
It's part of a unique program of frank talk about sexuality that has quickly become the largest AIDS prevention campaign in South Africa, and if it works it could become a model for similar efforts across that stricken continent and elsewhere around the world.
As United Nations delegates here in New York for the U.N. General Assembly's special session on AIDS contemplated a vast expansion of AIDS prevention programs in Africa yesterday, many of them said the aptly named LoveLife program could be a model for the kind of effort they have in mind.
The aim of the two-year-old LoveLife program is to sell AIDS prevention to a mass market of teenagers, much as the young are sold soda pop and popular music. There are LoveLife billboards, LoveLife television and radio shows, and LoveLife-sponsored recreation halls and sports events.
LoveLife was conceived when AIDS experts in South Africa were convinced that prevention efforts would go nowhere until teenagers and their parents broke their silence about sexual behavior and its consequences. The real meaning of the "oral sex" billboard is not to promote sex but to provoke honest conversation.
And though it is too early to tell if the program is changing sexual behavior among young South Africans, it is unquestionably reaching its intended audience. A telephone hot-line discussing sexual issues is logging 80, 000 calls a month.
Despite its saucy imagery, the core message of the "talk about it" campaign is to "think about" HIV and AIDS. "Clearly and fundamentally, this is about sexual behavior change," said Judi Nwokedi, director of media programs for LoveLife in Johannesburg, during a forum at the UN conference.
Such talk does not come cheaply. Begun as a partnership between the Kaiser Family Foundation, based in Menlo Park, and the South African government, the program is budgeted to spend $100 million over five years. The California foundation is picking up 60 percent of the cost, the South African government about 20 percent. Recently, the Bill & Melinda Gates Foundation joined Kaiser as a partner in the program.
The program has benefited from millions of dollars in free airtime donated by SABC, the country's largest television network.
South African youth are among those at highest risk in the world for HIV infection. An estimated 4.7 million South Africans are believed to be infected, the highest number of any country in the world. Half of the world's 15,000 new HIV infections that occur each day occur among young people ages 15 to 24, according to UNAIDS.
"Young people everywhere are at the epicenter of this epidemic," said Michael Sinclair, who directs South African programs for the Kaiser Family Foundation. "Clearly programs for youth need to be at the core of a successful prevention strategy."
At the United Nations General Assembly Special Session on AIDS, four young participants in the LoveLife program, with freshly minted black LoveLife T- shirts, described their involvement to delegates and reporters.
"In South Africa, people gossip across fences," said Mandla Sibeko, 22, who grew up in a rural area near the Mozambique border and now lives in Johannesburg. "But when you get people to talk about sex and HIV, it takes it to another level. It starts a debate that would never happen."
Nangamso "So-So" Koza is a 15-year-old girl from Eastern Cape, one of the poorest parts of South Africa. LoveLife, she said, is "youth talking to other youth about sex, about peer pressure, about problems at home."
Michelle Bowers, an 18-year-old from a township south of Johannesburg, said the LoveLife program has also opened up a dialogue between South African teens and their parents. "It gave me the skills to communicate with them," she said.
Sinclair said the overt discussions of sexuality, which are promoted over the airwaves and by loud-speakers at teen dances and sporting events, "would never fly" in the United States. "We're much too conservative a society," he said.
But the program, which was designed by South Africans for South Africa -- has drawn interest from abroad. "We've had a delegation from Nigeria and one from China that came to South Africa specifically to look at the LoveLife program," said Sinclair.
After three to six years, Sinclair said there will be enough data to know whether or not Lovelife is working. The sponsors of the program intend to measure such factors as condom usage, age of onset of sexual activity, and reported numbers of sex partners to determine if frank talk has made sex safer.
Meanwhile, young South Africans appear to appreciate an AIDS prevention program that offers more than gloom and doom. When Sibeko first heard about the new program, he feared it was another campaign like the one that used images of blood on a sidewalk to warn about the deadly effects of the disease.
But the message of LoveLife is relentlessly affirmative, he said, and that worked for him. "The more confident you are about life," he said, "the better you are able to share responsibility."
E-mail Sabin Russell at srussell@sfchronicle.com.
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