International Public Hearing on HIV and AIDS in South Africa Jack Lewis, SANAC TTT Personal Capacity

www.beatit.co.za Interdependence of treatment and prevention. Psychological and socio-economic factors in responding to HIV. Stigma and denial stem from a rational fear of death. Treatment is a precondition for overcoming fear and the stigma it gives rise to. Mass treatment literacy is needed as our communication strategy. People on treatment change their behaviour.

We see the effect of this fear in the inability of knowledge on its own to change behaviour. People know about AIDS but still take risk. 76% of South Africans who were HIV positive were not aware of their HIV status 63% of these who were not aware of their HIV positive status did not perceive themselves to be at risk Sexual activity is high: 70% of youth between 15-25 are having sex regularly, 41% of youth 15-25 had sex in the past 30 days between 1-4 times. Condom Use at Last Sex was low. Age Male (%) Female (%) 15-24 yrs 57.1 46.0 25-49 yrs 26.7 19.7 50 yrs+ 8.2 5.6

9. Between 2002 and 2007, antenatal prevalence increased from 24 9. Between 2002 and 2007, antenatal prevalence increased from 24.8% to between 28% and 29%.

Socio-economic barriers to behaviour change: Unemployment: Over 26% of the population is unemployed on the narrow definition of unemployment used by government. Housing: 15% of the population still living in informal settlements and many living very problematic public housing, Bad education and high levels of functional illiteracy which inhibits access to information and work. High levels of alcohol and other substance abuse and high levels of. SA men consume 5 measures of alcohol per day –per capita adult alcohol consumption is 10 litres pure alcohol per year - one of the highest rates in the world. gender violence: Over 50 000 reported rapes annually with only 1 in 9 rapes being reported and high rates (possibly as high as 50%) of women experiencing domestic violence in partnerships.

Full information on accessing treatment necessary at population level Full information on accessing treatment necessary at population level. Communications campaigns have failed to achieve this. Balance between behaviour change and treatment information needs to be improved. Better integration of treatment literacy and behaviour change is needed. Behaviour change needs to accept challenge of both treatment access and socio-economic barriers to be able to act on information of MCP and consistent condom use. Posing behaviour changes as something for individual will and psychology is to get less than half the story. Treatment information (HIV/AIDS, TB, STIs, MCH and others) can provide platform for further behaviour change. HIV/AIDS and health communication needs to be a pro poor programme.