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Fedics is a company which serves several million meals a day through its disparate company restaurants at business and manufacturing facilities around sub-Saharan Africa. That mission places it in a position to gain considerable insight into the effectiveness of HIV/AIDS education within large, predominately blue-collar workforces, as recently concluded research indicates.

Introduction
A recent Knowledge, Attitudes and Practices (KAP) survey conducted in KwaZulu-Natal, coupled with a renewed prevalence survey at facilities served by Fedics revealed several important points which may fly in the face of conventionally perceived logic. According to Alan Brand, Group National HIV/AIDS Manager at Fedics, many businesses appear to have been making a critical mistake not only in the way in which messages around HIV/AIDS have been delivered but also in terms of the content.

Shout louder
Brand says that a critical factor in the failure of HIV/AIDS programmes is the lack of frequency of the communication. To be clear, companies often make the mistake of assuming their people are experiencing HIV/AIDS info overload for which the perceived best remedy is to stop it for a while and to give them a break. But Brand says that the opposite effect is often achieved. “What you do when you do that is to give the indication that the problem is over. And once that happens, you get sidelined. What you have to do actually is constantly reinforce the message and if you don’t think it is working, turn the volume up, not down. Shout louder,” he says.

Failing to do that, the research shows, will lead to a crisis. “Stop the communication in one or other area and that is the very area that will show up with the highest prevalence next,” says Brand.

Get the message right
Results seem to show that we wasted the first 20 years of HIV/AIDS communication by driving home the message that the most logical response to HIV/AIDS should be fear. In fairness, we didn’t have a means of combating it, according to Brand, but the message became very clear: HIV/AIDS = Death. But while that may have been essentially true for many of those living with HIV in the past, it had a very negative knock on effect. “If you were going to die anyway, what was the point in knowing your status? Fear has never worked, it doesn’t empower people. It puts them in a weak situation where they are unable to take action,” says Brand.

“That is a message we have to change with a matter of urgency. We need to replace that sense of fear with the emotions and the feeling that people turn to when they are told they have other diseases. A diagnosis of cancer more often leads to a rational thought process about how to cure it, live with it or at least contain it so that the patient can continue with a productive life,” he says.

“When you start changing the communication around HIV, you start changing people’s attitudes towards it, towards knowing their status and coming forward to seek assistance. Because suddenly, it isn’t about dying, it is about living. When a person finds out they have HIV, they can take action, and have the ability and the capacity to protect others and themselves,” says Brand.

HIV today is a treatable and affordably manageable disease. Of course it still is not curable, but there are other diseases which are far more expensive to treat.

Beyond A-B-C to A-B-C-D-E-F
Brand says that data from research shows very clearly that prevalence is increasing, and so are deaths. This presents a real challenge for Fedics because it is entirely a people business. It doesn’t possess buildings or machinery, it provides personnel to provide services. He believes that the recent KAP findings prove the case for a broad-based approach to tackle the issue. “The old A-B-Cs of ‘Abstain, Be faithful, Condomise aren’t enough. You need to add a ‘D-E-F onto that and look at all available avenues. Because though our KAP survey shows that people have knowledge of how a condom might protect them, usage remains low. In Swaziland we discovered that even if their partners request them to use a condom, men typically will not do so. And it is devastating because in the same survey those men said that they know about HIV, they are frightened of it, and they are regularly burying people,” says Brand.

“And so it makes sense to add the Ds Es and Fs such as microbicides, circumcision and so on,” he says.

It is also important, Brand believes, to move away from the notion that behaviour can be passed off as a cultural or traditional more.?? “It is important to change focus and say it isn’t who you are that matters, it is what you are doing about who you are.
I can be a Zulu man or a white South African or a gay South African, and it really doesn’t matter. You can have someone who is “promiscuous”, but who is aware of HIV and is taking action to make sure they don’t contract it or spread it. That person is a hero in this epidemic,” he says.

Conclusion
Managing an HIV/AIDS programme is complex. Challenges build on challenges and many may believe that they are simply filling in gaps all the time. Yet finding such as those discovered by Fedics go some distance towards moving us all forward. There is no magic bullet and no ideal path to success. But if the paths highlighted above are indeed wrong, then you may put yourself in a far better position by avoiding them.

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