Brazil, Uganda Offer Insight into AIDS Prevention

The past success of Uganda and Brazil in fighting AIDS suggests that government openness and widespread education campaigns may help prevent the spread of the disease, according to a Duke professor who has studied AIDS issues around the world.

“ When I was studying AIDS in Africa in the Nineties, there were some countries that we thought were going to be devastated by the disease,” says Kathryn Whetten, assistant professor of public policy and community and family medicine. “We were thinking that literally generations were going to be wiped out. Brazil, in South America, was one of those countries, and Uganda was another. But that didn’t happen. We can’t say for certain what worked, but we can say what was unique about these two countries’ efforts to combat AIDS.”

Both governments took the AIDS threat very seriously, very quickly, and they weren’t afraid to talk about sex and condoms, she says. Both nations started widespread education campaigns, using a variety of means to get their messages out, including billboard and newspaper advertisements and radio broadcasts of songs recorded by the countries’ biggest pop stars.

Whetten stresses that, while funds are important, what appears to work is open communication throughout the country about the nature of the disease and its modes of transmission, a discussion that cuts across economic and social levels and cultural beliefs. In Uganda and Brazil, this discussion was started from the top down, but it can come from the grassroots as well, she says.

“ When we look at other countries at great risk now, we may find that their governments will be less inclined to be so open,” says Whetten, who is also the director of Duke’s Health Inequalities Program in the Center for Health Policy, Law, and Management.

The worst problems at present appear to be in Cambodia, Thailand, and Nigeria. But she predicts that both China and India will soon be facing widespread HIV epidemics. “What is common among those countries, except for Thailand, is that they are countries where the governments have been very conflicted about what to do about HIV and the social stigma of the disease. There remains a strong feeling that if you talk about the disease at any level—individual, family, community, or national—you are bringing shame.”

Strong religious beliefs are also associated with a failure to take firm stances on engaging in open discussions about stopping the spread of the disease, she says.