JIM LEHRER: Finally tonight, tackling AIDS through prevention. On the eve of World AIDS Day, President Bush asked for more money today to help fight AIDS. A key part of that is prevention.
Our health correspondent, Susan Dentzer, has been looking at such efforts in Tanzania as part of her series on AIDS in Africa. The Health Unit is a partnership with the Robert Wood Johnson Foundation.
SUSAN DENTZER, NewsHour Health Correspondent: Musan Ngalula dances and sings, urging people to get tested for HIV-AIDS. He’s trying to get the message to teens or young adults like him here in Tanzania. And Ngalula teams up regularly with fellow musicians in stylized native dress to drum home the message that HIV can kill. He knows that all too well.
MUSAN NGALULA, Tanzanian Singer (through translator): I lost both my parents to HIV. My mother passed away in 1995, and my father died earlier, when I was in the second grade.
SUSAN DENTZER: This and other outreach groups here in Tanzania are sponsored by the U.S. Global AIDS Initiative, also known as the President’s Emergency Plan for Aids Relief. As such, the groups are part of an urgent effort to prevent the 2.5 million new HIV infections now estimated to occur throughout the world each year.
MARK DYBUL, U.S. Global AIDS Coordinator: We can’t treat our way out of this epidemic.
SUSAN DENTZER: Ambassador Mark Dybul is the U.S. Global AIDS coordinator overseeing the program. He says, with roughly 33 million around the world infected with HIV and as many as 8 million of those already in need of anti-retroviral treatment, the world may prove unwilling to foot the bill to put all who need them on the drugs.
That’s a key reason why preventing even more cases is so critical and why the program has as its target preventing 7 million new cases by 2008. If it accomplishes that, it will have met a key test of its overall success, experts say.
"Relying on behavior change"
MARK DYBUL: Until we have a vaccine or a microbicide or pre-exposure prophylactics or some other technological interventions, we're relying on behavior change. And as we know from smoking campaigns, and getting people to reduce fat content, and these types of health behavior change, it takes a long time.
SUSAN DENTZER: Here in Tanzania, the effort to change behavior starts with the estimated 7 percent of adults believed to be infected. Making certain they know they're infected is critical, so they can change their behavior to avoid infecting others.
Tracy Carson coordinates the U.S. Global AIDS Program here.
TRACY CARSON, U.S. Global AIDS Program: It's preventing the 93 percent of the population who are uninfected now from becoming infected.
SUSAN DENTZER: And that's why last summer Tanzanian President Jakaya Kikwete kicked off a national campaign to get far more Tanzanians tested for HIV. He got himself tested first.
Dr. Bennett Fimbo of the Tanzania National AIDS Control program told us the government expects up to 5 million Tanzanians to be tested in the second half of this year.
DR. BENNETT FIMBO, Tanzania National AIDS Control Program: It empowers individuals. Once they know that they are not infected or they are infected, they access those services, in terms of care. They will also access preventive aspects. They will also access information, how to live with the epidemic, how to live with the virus in the body, and how to avoid transmission to other people who are not infected.
SUSAN DENTZER: Rehema Rajabu came for an HIV test at a mobile testing site in Dar-es-Salaam, Tanzania's capital. It's sponsored by the African Medical Research Foundation and supported by the U.S. initiative.
REHEMA RAJABU, Tanzanian Citizen (through translator): It was a very good thing that President Kikwete did, because I wouldn't have come to get tested if it weren't for him.
SUSAN DENTZER: At the end of the session, a counselor gave Rajabu the good news: The rapid HIV test showed she was negative. To verify the results, she was advised to be retested in three months.
Promoting "ABCs" in HIV Education
SUSAN DENTZER: For people who do test positive, there's counseling to use condoms. They're the "c" of the U.S. program's so-called ABC approach: abstinence; be faithful; use condoms. And there's no question that handing out millions of dollars worth of condoms has been a major part of the program's prevention effort.
MARK DYBUL: We supply more condoms than the rest of the world combined, so that's 1.7 billion condoms since this program started.
SUSAN DENTZER: As for the "a," abstinence, the U.S. program was required by Congress to use a third of its prevention dollars on programs that advocate abstinence until marriage. But various studies and public health experts have questioned the effectiveness of abstinence programs in changing sexual behavior.
And a 2006 report by Congress's Government Accountability Office said the abstinence requirement had interfered with the ability to deliver, quote, "comprehensive messages to certain populations." That could include people who already have AIDS for whom advice about abstinence isn't likely to be helpful.
In Tanzania, we saw how these ABC messages are really conveyed and that the on-the-ground reality is more complicated than the simple ABC rubric would suggest.
In fact, especially when aimed at young people, the messages are more like this: Abstain if you can, but if you can't, be faithful to one partner. If you can't do that, at least reduce the number of sexual partners you have so you're less likely to get or spread HIV.
A case in point was this gathering for Tanzanian high school students in Dar-es-Salaam. It was organized by a group called TAYOA, the Tanzania Youth Alliance, which is funded by the U.S. program. To the audience's delight, students role-played how to deal with each other on matters pertaining to sex.
"Baby, I love you," says this boy. The girl's response is noncommittal, but her manner conveys the clear message, "Get lost." Other students describe their solutions for avoiding HIV.
TANZANIAN STUDENT: I just want to be faithful. I have to confess. I really have a girlfriend, but it's only one, and I've been with her for three years. I just like to stick with the two methods: being faithful and abstinence.
Bringing messages to youth
SUSAN DENTZER: Peter Masika heads TAYOA, which is funded by the U.S. program.
PETER MASIKA, Tanzanian Anti-AIDS Activist: What we realize is that youth, they like very much to hear the message from their own fellow youth. If we don't bring these good, positive messages, good ideas and also prevention messages, empower young people so they can tell their fellow young people, like telling them abstinence is cool, it's good, there's no way that we are going to be successful.
SUSAN DENTZER: Even if sexually active youth just reduce their number of partners, Masika told us, HIV transmission will fall.
PETER MASIKA: You have to know that you are having relationships with all the other people he has ever had. And likewise, the boy is having relationships with all the other people.
We always tell them, "Take this into your imagination, into a big football ground, and try to think that you put all the beds around and try to think how many people you are sleeping with at one time. If you calculate, you can find that you are sleeping with maybe 3,000 or 2,000 people because of all these sexual networks."
SUSAN DENTZER: The U.S. program's support of HIV-fighting efforts like these are likely to get a close look soon in Washington.
The original five-year program was passed in 2003, but to continue beyond 2008 it will have to be extended by Congress. And experts say that, in the future, the program will have to focus more than ever on areas like prevention.
Reaching youth through radio
SUSAN DENTZER: Global AIDS coordinator Dybul told us that means thinking of new ways to reach young people around the world.
MARK DYBUL: There are organizations in the private sector that live and die on whether or not they change a young kid's behavior, whether it's going to a movie or drinking a certain soda or buying a certain toy. We need to take that type of messaging, that type of 21st-century approach.
SUSAN DENTZER: We got a glimpse of that future recently in this impromptu recording studio in Dar-es-Salaam. A group of Tanzanian actors was taping an anti-HIV radio spot.
The radio spot was the brainchild of a Stanford Business School professor, Chip Heath. He was brought over by the U.S. Global AIDS Program to help craft a new HIV prevention campaign.
CHIP HEATH, Stanford University: One of the important problems in Tanzania is intergenerational transmission of AIDS. You get older, wealthy men picking up young women and infecting them with AIDS, because poverty is such an issue that the young women are seduced by these older, wealthier, more distinguished men.
SUSAN DENTZER: So Heath told us he and his colleagues invented the character Fataki, or Swahili for explosion, to try to create an influential negative cultural stereotype.
CHIP HEATH: Fataki is this lecherous character that's always trying to pick up women in some form. He's wealthy. He's smooth. But in every case, when he tries to pick up a young woman, there will be a friend in the positive messages that intervenes and says, "Don't you know that guy? His wife died of AIDS." And then they start running away, and Fataki is going, "Hey, wait, baby, what's wrong?"
The announcer comes on and says, "Don't let your friends fall prey to Fataki." And what we're hoping is that it's going to become a catchphrase. "He's such a Fataki. You know, he's such a lecher."
SUSAN DENTZER: Back at the mobile testing center, we watched as a group danced and sang their own prevention messages.
"Get tested," sang this man. He has HIV. So does this woman. With the backing of the U.S. program, they're hoping to help others avoid the same fate.