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AIDS PREVENTION PRO - Roots for a new kind of prevention

New generation of prevention techniques like "HIV prevention pill/injection" (which will allow to skip the use of condom without danger), "HIV preventive foam" (to spray in vaginal or rectal cavity before penetration) or "HIV preventive vaccination" (...) are NOT subjects of our pages. This new technologies are still medical experimentations. We prefer to stay in grass rooted problems induce by generalized techniques of prevention

1- Why "classic" campaigns are no more efficient?

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Here is a list of causes which can induce dangerous sexual attitudes in population where "first line" prevention messages (condoms/ abstience/ safe sex/ basic knowledge about HIV) were already correctly disseminated. Each of those topics could be potentially tackle by "second line" prevention campaigns but not all have same importance for epidemic consideration. Grass rooted analyses are nearly always required.

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100- Psychological & medical causes

101- Shyness

• 01- Too shy to buy a condom.
• 03- Too shy to have a condom in her/his bag/room which can be see by parents/friends/fixed partner.
• 02- Too shy to ask to partner to wear condom during intercourse protocol. (note here that shyness is not the typical psychological emotion associate with the lack of sexual experience/maturity and which can also induce the impossibility of speaking during intercourse -see 102.01).

102- Fears

• 01- Psychological fears induce by lack of sexual experience/maturity. It is quite common that such anxiety reduce the ability to speak (and to think correctly) during intercourse... Unfortunately, only sexual practice can improve sexual experience/maturity. Prevention material can not induce maturity. But prevention material can increase the awareness and, by that way, speed up the maturity process
• 02- Fear that partner will leave if insisting too much on safety requirement. That fear is more severe in love context or financial precariousness.
• 03- Fear of temporary impotence that condom can induce. Our own Impotence is still a taboo in male's conversation (but not the impotence of the others!...). Often, it is the underlying cause of refusing condom and man will use specious argument to hide the real cause (to himself and to his partner). I observed even in the professional sphere "strategies" to bypass or to deny such kind of problem. (The success of "viagra" and the style of numerous spams indicate that the problem is not marginal.)

103-Pleasures disturbance

• 01- "Less feeling". It is definitively a true side effect of condom but following our conviction, it not a true cause of refusing condom since the "normal man" will not refuse a Mercedes Benz because he prefer a Roll Royce. This argument is typically use to hideanother cause (typically: impotency).
• 02- "Delayed orgasm" of male. Connected with 103-01 & 102-03. Can be consider as an advantage as well by woman and some men.

104-Love

• Love induce psychological blindness and fears which can induce dangerous atitudes (see also 102-02)
• Love is wrongly associated with confidence...

• Love is also typicaly stronger in adolescence which is commonly associate with lack of experience.maturity (see 102-01)

200- Intellectual causes

201-Generalized intellectual disturbance

• 01- Lack of instruction. Unable to deal correctly with scientific information.
• 02- Natural lack of intellectual resources: poor QI, mental diseases.(rare)
• 03- psychological diseases which induce wrong decision because unbalanced relation between "logical requirement" and "affective requirement" ...We can include in this causes the excessive feeling of solitude, the "excessive" feeling of love.

202-Gaps in medical knowledge

• 01- Dangerous optimism regarding progress of medical sciences
• 02- Conviction that HIV is now curable disease
• 02- Under evaluation of treatment constraints

300- Social & cultural causes

301-Alcohol, narcotics...

• 01- Alcohol. Alcohol is the cause of millions of contaminations because alcohol induce a misevaluation of a danger, reduce ability to wear correctly a condom (nails...), reduce ethic alertness...
• 02- Psycho stimulants ("extasy", "cocaine"... which are also use as erectile drugs) (see 301-01)
• 03- Other narcotics. Can add another danger in the list of dangers induced by other drugs: the addiction! Addiction can drive to very dangerous behaviour ("wild prostitution"...)

302-303-Relion - ethic failures....

• 01- To have a first dangerous attitude (dangerous bets...) consern directly our éthic auto evaluation...
• 02- ...but to have a second dangerous attitude without checking first the blood in nothing less than a potencial murder... but who considrt it really?
• Links between ethic and religion..
• Integrism and consecutive stigmas...

304-Stigmatization

• 01- Can increase the fear to test the blood.... by the fear of dicremination that positive result can induce.
• 02- Increase the natural tendency to hide a positive result... The taboo encourages a misevaluation of the risk.
• 03- The stigmatization even drive to ignorance since looking for information can even look as a suspect attitude...

305-Fear to induce "moral corruption"

• 01- Parents can fear that making condoms available to kids can corrupt them by inducing or encouraging sexual activities. That is a common wrong thinking. At least for youngs and for imature adults, it is not the presence or the absence of condom who will be the crucial argument. Shyness, anxieties, fears, lack of opportunities, alcohol (...) will be the limitating factors, NOT the availability of condoms.
• 02- Wives or "official partners" can fear that to put a condom in the pocket of partner can increase the risk or encourage extraconjugal relations. That is only partialy true. But condom in pocket do not change the ethic value or the love of a partner! It is not the presence or the absence of condom who is crucial. It is all the conjugal life which should be reestablish on realistic roots.

400- Logistical causes

401-No availability of preventive tools

• 01- Condom & lubricant
• 02- Information
• 03- HIV test (anonymous or not, free or not.)

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2- Roots for a new generation of prevention campaigns (Theory)

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A- Vocabulary

"Material" refers to an entity which includes mainly 3 leading components: a target group/subgroup (for instance: the group of the agrarian homosexuals), a media (for instance: poster) and one or two leading message(s) (for instance: first or/and second line of messages).

"Message" is the content that a material is suppose to disseminate and which is suppose to induce reduction of unsafe attitudes in the targeted group/subgroup.

"First line" of AIDS prevention messages refers to the scientific, technical and logistical basic information that can not be ignored by anyone concerning HIV/AIDS ways of contamination and relevant prevention (for instance: "you can not catch HIV by mosquitoes" or "condom reduce the risk of HIV transmission").

The former HIV/AIDS prevention campaigns have mainly focused on first line HIV/AIDS prevention messages.

"Second line" of prevention messages refers to messages that can only be delivered if the "first" line of prevention messages has been delivered and received among the target group/subgroup. This "second line" of AIDS prevention messages is more focusing on reasons why people are not following the first line of prevention messages that they know. This may be relevant to psychology, sociology or culture and may not be directly related with the specific characteristics of HIV/AIDS disease.The virtual concept of "first" and "second" lines of AIDS prevention messages may be difficult to understand. Here is one example to clarify this concept. More than 90% of Thai men are aware that they should use condoms when having casual sex or a new sexual partner. This awareness came from the first line of AIDS prevention messages. But, in the reality of life, some of them are not using condoms and are evoking different reasons such as afraid of impotency, less feeling, fear of partner's opinion, etc. The "second" line of AIDS prevention messages must tackle directly these reasons and focus on "why are these men not following the well known AIDS prevention recommendations?"

"Target group/subgroups" is the ensemble of persons for which a material is dedicated. We have to make the distinction between "target group/subgroup" and "audience group/subgroup".

"Audience group/subgroup" is the group of persons who will be in contact with the material which was made for a specific "target group/subgroup". Example: a TV spot (="media") can deliver a "message" specifically designed for homosexuals ("target group") but prevention campaign designers must be aware of the impact that such "material" can also have on the others groups/subgroups included in "audience group/subgroup" (everybody can see TV). The impacts can be very useful or counterproductive (scandal, compassion, stigmas, etc). We can imagine for instance that to disseminate a specific "message" in the "target subgroup urban + teenager" it could become a necessity to have an "audience group" which include parents or teachers.

Difference between first and second line messages is fundamental in HIV prevention. It is why we dedicate a few explanations to make things clear.

Suppose you want to protect your child from HIV. First of all, your child must know:

• What is HIV and AIDS.
• Ways of transmission of HIV.
• Ways to avoid contamination (in practical terms).

We call that "first line prevention". Fore more details click here

C- Second line prevention

In western countries, in Thailand and many others countries we observe new contaminations in the groups of people well informed by "first line prevention" (knowing the danger of HIV and the way to prevent contamination). We touch here the structural limits of "first line prevention". The causes of insufficiency of "first line prevention" may be relevant to psychology, sociology or even culture and may not be directly related with the specific characteristics of HIV/AIDS disease. Observing why such informed people became infected we find causes like: side effects of shyness, side effects of alcohol, fear of sporadic impotence induced by condoms, etc

We definitively need another kind of prevention campaigns which tackle such topics and that we call "second line prevention" (“second line” because such prevention is useless if “first line" messages are not received previously).

Example: it is reported than more than 90% of HIV infected women in Thailand, are faithful wives and have been contaminated by their husband or single partner. The husband knows very well that because of his unprotected extra conjugal sex relationship with a sex worker for instance, he is at high risk to be HIV infected. He knows the risk through the first line of AIDS prevention messages. But it is definitely true that it is extremely difficult for him to confess to his wife that he had an extra conjugal affair. It is easier for him to lie or to hide his extra relationship than to confess it to his wife. Such situation is definitely leading the husband to infect his wife with HIV.
The second line of AIDS prevention messages must take up the challenge and must find the most appropriate way to enter upon this sensitive issue. It must deal with realistic understanding of the husband, with the efficient protection of the wife against HIV and with the respect of the couple as an entity.

It is important to insist here on the necessity of deep analyses of each "pretext" that people having unsafe practice will use to justify their attitude. A young student will possibly tell us that she accepted unprotected relation with her partner because she was confident to him.. It is more easy to speak about the confidence she had than to confess that she was just afraid to loss her partner that she love so much.. Even more typical is the male who refuse condom because the condom "reduce his feeling". It is definitively true that condom reduce feeling. But a normal person will not refuse a Mercedes Benz because he prefer a Roll Royce isn't? In fact, it is more easy to use such pretext than to admit that the reason of his unsafe attitude was his fair of impotency (which is a possible sporadic side effect of condom) or his impatience because he had no condom in his pocket and was mentally too weak to accept to deadly a little bid the sexual intercourse.

For more details click here

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3. Target groups/subgroups; need to consider sociologic tools.

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There are many ways to divide a population into groups. It can be based on criteria such as "Muslim/Buddhist", "migrant/native", etc.

Some well known epidemiological tools divide the society into groups based on criteria like "male / female", "child / teenager / adult / old ", "married / single", "homosexual / heterosexual", etc.

The combination of different division criteria will already define some "subgroups" and can be useful to primarily identify new high risk communities and to elaborate basic prevention strategies.

For instance, to tackle the sensitive issue of intra conjugal HIV contamination, the prevention strategy will probably focus on moral argumentation's in the subgroup "male and teenager", use concrete alarming arguments in the subgroup "female and married" and emphasize on post exposure actions to be taken in the subgroup "male and married".

Another well known epidemiological tool is to divide the society into four groups which are:" tribal / agrarian / industrial / post-industrial". Some specific characteristics for each group are described in annex1 (bottom of the page) . In Thailand, these four sociologic groups are well present and are unequally affected by HIV/AIDS epidemic.

It is already quite evident that for each of these four sociologic groups, a different strategy is needed, not only as per the contents of the AIDS prevention messages, but also for the way of disseminating the required messages.

For instance, to exhibit details about some marginal sexual practices related to homosexuality may probably only intrigue the tribal group but such words or images are simply unsuitable for the agrarian and industrial groups as such information may induce contra productive psychological shocks. Dissemination strategies must be extremely aware of that.

In the Thai context, it is definitively the combination of this major epidemiological tool with one or more other classification criteria that will be most helpful to determine specific high risk subgroups, to elaborate fully efficient prevention messages, to elaborate clever dissemination strategies and to identify lacking prevention materials.

For instance: AIDS prevention materials dealing with homosexuality are quite abundant but are mainly available for the subgroups "male + homosexual + industrial" and "male + homosexual + post industrial". AIDS prevention materials for the important "male + homosexual + agrarian" subgroup are scarce. Such materials should consider the fact that, in the agrarian group, gay's life is not structured as gay's bars, specialized magazines, etc. are hardly available. Booklets that will include explicitly the concept of homosexuality will hardly be openly distributed by agrarian public institutions. By consequence, the best way to disseminate the info's concerning homosexuality in agrarian area is probably to include them in the material dedicated to heterosexuals.. but with caution.. to avoid that agrarian heterosexuals reject such kind of material, etc

Annex 1.

Some intellectuals divided the humanity in four major societies or groups which are: the tribal, the agrarian, the industrial and the post-industrial.

Although these divisions are never totally clear, they can be considered as a appropriate and quite operational sociologic tool which helps the project to enter into topics closely connected with HIV/AIDS prevention, such as sexuality, marital status, morality, intra-familial relations, authority etc.

For the purpose of the project, it must be mentioned that these four sociologic groups are well present in Thailand .

Here enclosed a brief summary about the main specificities of the four sociologic groups.

- Tribal groups:

• Proportionally the most HIV affected group in Thailand .
• Usually living in quite isolated rural and mountainous areas.
• Large family structure including all generations and servants in the same house. Polygamy is not rare and concubines can be officially included in family clan.
• Fecundity and family structure are still the main "social security" guaranty.
• Sex verbalization is low but with low puritan constraints.
• Sex marginalities are not structured.
• No or low privacy in social and family life. Secrets are difficult to be protected.
• Religious believes are important but not very influent in sexual life.
• High mobility of members inside and outside the tribe.

- Agrarian groups:

• The biggest group in Thailand , mainly living in rural areas and in little towns.
• Families include all generations in the same house.
• Fecundity and family are still considered as the main and best "social security" guaranty.
• Sex verbalization is low and puritan constraints are common.
• Sex marginalities are not structured.
• Low privacy in social and family life. Secrets are difficult to be protected.
• Religion is important and influent in both sexual and ethical fields.
• Highly concern with multi level hierarchy and sophisticated politeness protocols which induce a systematic use of "social mask" to preserve social order.

- Industrial groups:

• The most growing group in Thailand , mainly living in urban areas
• "Nuclear families". Just a few kids. Grandparents are usually not living in the same house.
• Employer, assurance or government are the main "social security" guaranty.
• Sex verbalization is low and puritan constraints are the strongest.
• Sex marginalities are becoming structured, but generally hided and stigmatized.
• High level of privacy in social and family life.
• Superficial concern with religious and ethic arguments concerning sex.
• Systematic use of "social mask" to preserve social order.
• Good instruction level and good receptivity to information.

- Post-industrial groups:

• The smallest group, living in big urban or international tourist area, often issued from rich layers of the society.
• Very low fecundity, celibacy is common.
• Many different "family" models with or without many generations in the same house.
• Sex verbalization is high. Low concern for puritan considerations.
• Sex marginalities are openly structured.
• High level of privacy in daily life.
• High level of information.
• Low concern with religious or ethic arguments which can even be contra-productive; but more concern with "new international culture".

For more details on this complex and specialized subject, interested readers can refer to the books of sociologists such as Toffler (US) or Brockmoller (German).

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