Who’s Fronting the Bill for the ‘Boards?

Who’s Fronting the Bill for the ‘Boards? Rights-based Education Through Billboards.

After miles of blank fencing along the roads in Kampala out pops the composition of parliament and the electoral cycle painted on the fence for people to read. It details the importance of voting and the special groups represented in Parliament, such as women, workers, persons with disabilities, and youth. I was intrigued by the creativity in public education, so began to think. How does this form of public education relate to women living with HIV/AIDS? What are the creative ways that advocates and officials use billboards to combat HIV/AIDS-related issues?

In Fort Portal, we visited the Manna Rescue Home where we toured, among other facilities, the schoolhouse. There were big posters detailing child protection and children’s rights. They included phrases like “Children rights are natural freedoms which all children should have and enjoy,” and “Examples of Children’s Rights: A right to have education, a name, medical care… .” Civil society is calling for a rights-based approach to be applied in the education and legal system in Uganda, as human rights violations are not often talked about. Many people are either not aware of their rights, or do not feel empowered to demand respect for their rights; this makes it difficult to seek legal redress if they face discrimination at work, gender-based violence, rape, or other abuses. Educating children about their rights at an early age is extremely beneficial, so they are empowered as adults if they experience a human rights violation.

The team in Rakai saw posters specifically targeted towards women with phrases like “He got circumcised and we use condoms. That’s our way of stopping HIV. What about you?” Research suggests that adult male circumcision can reduce the chance of contracting the virus for heterosexual men by 50-60%. According to UNAIDS, the percentage of circumcised men aged 15-49 who are circumcised is 26.8%. Adult male circumcision is not found to reduce the risk of infection for men who have sex with men (MSM) or women who have sex with an HIV-positive circumcised man. However, for HIV-negative heterosexual men, circumcision can be very health-conscious. The foreskin is highly vulnerable to infection due to the higher concentration of Langerhans cells, the high likelihood of small tears during intercourse, and the possibility of HIV-infected fluids getting trapped under the foreskin. As many men in Uganda are uncircumcised, there has been a big push in recent years to make it more socially acceptable. Now many health clinics in Uganda are providing free and safe adult male circumcision.

In Kampala, we learned that the United States Government also funds billboards and media ads to combat stigma and GBV. They include messages like “I use condoms to keep myself safe.” According to UNAIDS, reported condom use among sex workers is 69.4%, and MSM is 39%. When asked adults aged 15-49 if they used a condom the last time they had high-risk sexual intercourse, the percentage who answered yes were: 45.5% of women, 60% of men, and 50.7% of all adults. If used correctly, latex condoms are highly effective in preventing the sexual transmission of HIV. It is a public health risk that only half of the adult population uses condoms during high-risk sexual intercourse. Many women feel that they cannot negotiate safe sex with their partners, married or not. Many think that it’s a husband’s right to have sex with his wife however he wants, and women fear gender-based violence (GBV) if they refuse sex or negotiate for safe sex. Posters aimed at making condom use more socially acceptable are extremely valuable because condoms are highly effective at stopping the transmission of HIV/AIDS.

The AIDS Support Organization (TASO) in Kampala has posters in their office about the importance of Antiretroviral (ARV) medication. ARVs are made largely available through a combination of government and international donor funding. ARVs do not cure HIV/AIDS—there is no known cure—though they do slow down the virus’ attack on the immune system. With strict ARV compliance, HIV-positive persons can live long and healthy lives, and prevent mother-to-child transmission. We heard many reports of people—especially youth— living with HIV not taking their ARVs because they felt healthy or were troubled by the initial side effects (dizziness and headache). If HIV-positive persons stop taking ARVs, not only will the virus strongly attack their immune system, they can develop a drug-resistant strain of HIV that will limit the effectiveness of ARVs in the future. Misinformation about ARV compliance kills people, and civil society needs to educate the public about the necessity to be compliant.

In Rakai there, we also saw the poster “I help him take his ARVs. That’s my way of stopping HIV. What about you?”. Men and women exhibit different health-seeking behavior in Uganda. It is more socially acceptable for women to go to health clinics than men, as women can see the doctor when they take their children. If men go to the doctor, they are seen as weak in society. If both partners are HIV-positive, often women will get their ARVs from the clinic, and the husband will take half. This is detrimental to the health of both persons, as ARV noncompliance can have disastrous effects. Not only do men need to increase their health-seeking behavior, but society also needs to give them the acceptance to do so without criticism.

I saw many commonalities in these posters. The posters in Rakai featured young and healthy looking women, which is an important step in tackling stigma. Many people have the misconception that if you have HIV/AIDS, you cannot lead a healthy life or have a healthy family. In fact when HIV/AIDS first surfaced in the Rakai District in the 1980’s they called it the ‘slim disease.’ However, now that knowledge and treatment of HIV/AIDS have advanced, people can lead healthy lives and prevent mother-child transmission with proper treatment. Featuring men and women who look healthy can start to break down this aspect of stigma.

Another important aspect to tackling stigma is including sex and HIV/AIDS education. Billboards on ARV compliance, condom use, facts about HIV/AIDS, for example, will familiarize people with these subjects and make them more common to discuss. There is a lot of misinformation regarding HIV/AIDS, and public education needs to combat them. Not only can posters with sex and HIV/AIDS education help dispel such misinformation, but they can also make it easier for people to talk about in their daily lives, negotiate safe sex, and discuss their status with their partners without fear of repercussions.

Much is being done already, though more can certainly be done. In Fort Portal, we did not see any signs in public to combat stigma and suspect that other rural areas are lacking as well. Additionally, there is little buy-in from the government for public sensitization regarding women’s rights, as most of the push comes from civil society and international donors. This is a very important aspect of protecting the human rights of women living with HIV/AIDS in Uganda.

#HIVAIDS #publiceducation #publichealth #HumanRights