New Strategies in the Battle against HIV/AIDS

Scholastica Sylvan Kimaryo et al., eds. Turning a Crisis into an Opportunity: Strategies for Scaling Up the National Response to the HIV/AIDS Pandemic in Lesotho. New Rochelle, N.Y.: Third Press Publishers, 2004. Figures. Tables. Appendixes. Index. xxx + 300 pp. $25.00. Paper.

This may be the first "how-to" manual that kicks off with a familiar Sesotho invocation: "Khotso, Pula, Nala" (Peace, Rain, Prosperity). Yet, given the high HIV prevalence rates in southern Africa—28.9 percent in Lesotho and an average of 30 percent for the SADC countries in 2003—it is unlikely to be the last manual we will see. Turning a Crisis into an Opportunity, the handiwork of a U.N. interagency theme group, addresses HIV/AIDS in Lesotho. It is written primarily by Africans—U.N. resident reps from UNAIDS and UNDP based in Lesotho—and results from a national consultative process involving government officials, bilateral stakeholders, and a cross-section of other citizens, including journalists, police, youth, and university representatives. In October 2003, the plan was adopted by the government of the Kingdom of Lesotho as an official working document to guide the country's national response to the pandemic.

The authors' aim is to manage Lesotho's HIV/AIDS crisis by breaking the population into two groups—those uninfected and those infected—and identifying appropriate interventions to address the needs of each. The goal is to ensure that every individual who is not infected remains so by taking the necessary preventive and behavioral measures, and that those infected receive the proper care, treatment, and support needed to live longer and improve their quality of life. The primary strategy put forward is to make certain that every Mosotho becomes "HIV/AIDS competent," a term employed by UNAIDS to refer to a society that is fully knowledgeable about HIV. This is an ambitious goal for any country: According to UNAIDS, 95 percent of those infected globally do not know their HIV status. Stigma, discrimination, and misinformation still attach themselves to conceptions of HIV/AIDS and to the growing number of people living with the virus.

For anyone interested in national responses to address HIV/AIDS, especially in Africa, this publication offers a number of innovative concepts and approaches. For example, in a chapter on social mobilization the authors discuss the instrumental role that local councils and local communities can play in implementing and scaling up HIV/AIDS interventions in villages across Lesotho. The authors observe that a commitment by local government is crucial to addressing HIV/AIDS and that through decentralization of governmental authority, popular participation in the decision-making process is increased. This creates a more accessible government, one more knowledgeable about local conditions and more responsive to the health needs of its citizens. The authors propose the formation of clear structures at the local level: district HIV/AIDS task forces to design and implement culturally appropriate responses, with comprehensive HIV/AIDS training provided to local counselors so that they may take a leadership role in their communities. This approach reinforces the best practices identified within the international literature: that direct involvement of communities is one of the critical factors to ensure success in managing HIV/AIDS.

In an insightful and sensitively rendered chapter on culture and communication, the authors observe that messages of critical public health significance are communicated to Africans primarily from outside the continent. They maintain that such efforts tend to fail because Africa has its own "cultural immune system" (140) that resists and often rejects messages from outside. Resistance to HIV/AIDS strategies and policies has been particularly strong because the earliest efforts at determining the origin of the virus pinned the blame on the African continent. To tackle the phenomenon of cultural immunity, the authors suggest that traditional forms of communication be harnessed to spread the word about HIV/AIDS and to indigenize the collective responses. For example, they advise changing the...