Dynamics of Awareness and Prevention in HIV / AIDS Policymaking

¶ … Rates and Preventative HIV / AIDS Policy: A Disconnect in African Countries

The primary focus of research in HIV / AIDS has been on the disease itself: transmission, prevalence, prevention, treatment, etc. (Aldashev & Baland, 2013). The responses to the HIV / AIDS academic have varied widely and are not intuitive, showing no logical patterns with regard to prevention policies and prevalence (Aldashev & Baland, 2013). That is to say that high prevalence rates in regions or nations do not trigger more aggressive policies. A key example of this phenomenon can be seen in Senegal's response to early proactive education programs for AIDS prevention that was completely out of proportion to its very low prevalence rate of 1% of the population of Senegal in 2003 (Aldashev & Baland, 2013). In comparison, Swaziland and Zimbabwe, countries that experienced extremely high prevalence rates of 24.6% in 2003 and 42.6%, respectively, exhibited limited public agency responses to the HIV/AID epidemic (Patterson, 2006).

Interestingly, the AIDS Program Effort Index (API) shows that in those countries with the highest rates of prevalence -- defined as over 10% of the population -- the prevalence rates among adults 15 to 49 years of age in 2003 showed a lower API score on average than do countries that exhibit the lowest rates of prevalence (Aldashev & Baland, 2013). Survey data for the API come from USAID, UNAIDS, and WHO as a tool for national governments battling the HIV / AIDS epidemic to gauge prevalence trends (Aldashev & Baland, 2013). In concert with this dynamic, the research shows that there is no demonstrable relationship between the prevalence of HIV / AIDS and public support for prioritzing effective prevention policies (Aldashev & Baland, 2013). The logical conclusion is that the elctorates in these countries do not consider battling HIV / AIDS as political priority (Aldashev & Baland, 2013). Moreover, the evolution of HIV / AIDS policies over time do not correspond to the variance in prevalence trends. Substantive changes in the policies are exacted with little apparent regard for the need for a coherent long-term disease reduction plan. A solid example of this policy problem is seen in Uganda where active prevention policies were enacted early in the epidemic: a successful campaign to prevent the disease was promoted by President Museveni in 1986.

The memorable slogan was Abstain, Be faithful, use Condums (ABC) and during the 1990s, the ABC campaign achieved substantially lower rates of prevalence (Alsan & Cutler, 2010). But in 2003, the policy focused only on abstinence as pressure was brought to bear on the president and the government by First Lady, Janet Museveni, evangelical churches, the U.S. PEPFAR aid program. As a result, condoms were soon in short supply and condom use fell substatively, while prevalence rates increased notably by 2006 (Patterson, 2006; AVERT, 2012).

A key finding is the cyclic factor that aspects of policy and prevention demonstrate. To wit: Awareness regarding the prevention policy are impacted by the impact of behavior change on prevalence rates and by the reduction of infection risk, which further strengthens political support for prevention policies in the future (Aldashev & Baland, 2013). This steady state equilibria of the two main factors (awareness and prevention policy) is fragile, however, as the natural inclination in developing countries is to suggest less aggressive prevention policies, with the inevitable results (Aldashev & Baland, 2013).