“C” before ABC — an Alphabet for HIV Prevention

“HIV prevention used to be about knowing your ABC’s: A for Abstinence, B for Be Faithful, and C for Condoms — Consistent Condom use. And when science showed us the value of male circumcision, I was pushing a new C, Circumcision …” Dishon Gogi pauses, and I remember his skills as a community organizer.

When I met Gogi, in Kenya’s Nyanza province, where the HIV prevalence is almost three times higher than in the rest of the country, he was the Social Mobilization Coordinator for the Nyanza Reproductive Health Society in two districts in Nyanza. Journalists would encounter him on field trips and described him as a circumcision crusader, a persuasive orator, who used his way with words to win over people for whom male circumcision was a foreign practice.

Cards filled out with answers
Cards from the 2012 World AIDS Conference in Washington, DC. Credit: Internews

Results from trials in Kenya, Uganda and South Africa had showed that circumcised men were only about half as likely as uncircumcised men to contract HIV from infected women. HIV penetrates easily into cells close to the inner surface of the foreskin. So removing the foreskin gives better protection. Kenya moved swiftly to introduce a Medical Male Circumcision drive.

“Numbers aside, it just means circumcision works, and we had to get men to be circumcised,” says Gogi. “Abstinence — it’s difficult. Be faithful — it’s not always possible. Condoms — passion gets in the way, and in my new job I take from what I’ve learnt as a mobilizer. I tell my students there’s another C that is the most important: Communication.”

“I tell my students there’s another C that is the most important: Communication.”

Gogi says if people don’t know about circumcision or any of the other ways to prevent HIV, and if they do not discuss it in their homes and with their neighbors, all the smart science would be of no use.

2 journalists in a studio
Kenyan journalists on a live radio show focused on HIV.

Gogi now teaches Communication and Psychology at the Medical College in Nyanza, ensuring nurses and health workers can translate their knowledge to the people they treat. He wants them to find ways to ensure their patients actually take up the benefits that HIV science has to offer, and that must be done by speaking to their heart, he says.

Scientists attending the 8th International Aids Society Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver (19 -22 July) are pondering the same issue. Several sessions at the conference will look at the missed opportunities for HIV prevention and at ways to increase the uptake of voluntary medical male circumcision (VMMC) in countries with high HIV prevalence.

Simply put, the most promising research findings will only help people if they make use of it.

The World Health Organization reports a recent upturn in the number of male circumcisions performed in 14 priority countries of East and Southern Africa. Since the start of VMMC programs in 2008, more than 9 million men have been circumcised, but to make an impact on the epidemic, the organization has set a target of 20.8 million males by 2016. “That’s a lot of unfinished business,” says Gogi.

Gogi says he tells his students Kenya’s early uptake of VMMC was because of two tools that are allies of medicine: tireless mobilization in the community and a credible media that told the stories of ordinary people and their fears and dreams and how getting circumcised made them heroes of healthy behavior.

Photo from The Kindest Cut book
Kenyan photographers worked to document the VMMC process, in an effort to accurately portray the procedure, its benefits, and risks.

His teaching materials include a stash of copies of print stories on VMMC and a copy of The Kindest Cut, a series of photo essays on the family experience of VMMC on the shores of Lake Victoria.

Gogi’s confidence in the role of the media is supported by a 9-page case study based on a news content analysis conducted by the United States Agency for International Development (USAID) and AVAC (a global advocacy group for HIV prevention) which finds that accurate and engaging media coverage in Kenya helped drive demand for VMMC. It highlights the lessons learned to help other countries in their VMMC scale-up efforts.

The AIDS conference in Vancouver places high emphasis on lessons learned and implementation science this year — a relatively new field of study that looks specifically at how to deliver new treatments to patients faster and at what it is that makes them take an interest.

For Gogi, the answer is in the C of Communication. “When people can read about it and hear it on the radio, it becomes a discussion point. They may not agree at first, but at least it becomes a normal part of life. Good media stories take the stigma away, and then people will feel the need to change from the heart.”

Internews in Kenya worked with journalists to tell stories on VMMC that are scientifically accurate, that dispel myths and depict the experiences of men and their families who took up this HIV prevention tool. Scientists, doctors and health workers were also trained to effectively engage the media on aspects of VMMC research and implementation. Ida Jooste is Global Health Advisor at Internews.

(This story was originally posted on Medium.)