Say Yes, Winter 2003: Understanding AIDS

A group of children reach up to touch their hands together. Photograph by D Berry/Photolink © 1999

Making contact -- the HIV/AIDS virus is not spread by everyday contact.
Photograph by D Berry/Photolink © 1999

When Acquired Immune Deficiency Syndrome (AIDS) first made headlines in 1980, few could have foreseen the terrible shadow which the unforgettably deceptive mnemonic of AIDS is now set to cast over generations to come. Although the HIV retrovirus is an opportunistic infection with no will or agenda of its own, we talk of the ‘war’ against AIDS as if it were some otherworldly invader. In truth, the war is with our own very human qualities of ignorance, fear and prejudice and we can only arm ourselves for such a battle -- adults and children alike -- by being informed as individuals.

The HIV/AIDS virus is transmitted via blood, blood products, semen and vaginal secretions. It cannot survive outside of its host and it cannot be transmitted by normal social contact such as touching, breathing the same air, sharing food or even kissing.

During the early ‘eighties, when AIDS was still very much a mystery, many people in the United States and Europe were infected by transfusions of infected blood. However, commercial blood donation has long since been banned in most parts of the world as it has been here in Turkey. Today, all blood donations and products such as plasma derived from blood are assiduously screened for evidence of the virus. Cases of infection through blood are mostly the result of intravenous drug users (IDUs) sharing needles. Since the number of IDUs in this country is quite low, it follows that most cases of infection are the result of unprotected sexual intercourse. As with other sexually transmitted diseases, strong condoms are the only protection against transmission of the retrovirus.

Although the disease is a global issue, a pandemic as opposed to an epidemic since the fight to control it extends well beyond the borders of any given country or continent, the personal matter of sexual behaviour is critical: social mores about sexual behaviour are the ‘minefields’ of this ‘war’.

While all HIV testing and treatment is principally covered by the Government, the primary objective is to negotiate these ‘minefields’ in order to inform those who are most at risk of infection. UNICEF works closely with the Ministry of Health (MOH) and other non-governmental organisations (NGOs) on education and awareness campaigns.

Holiday Snaps

The disinhibiting effects of travel are marked. On business or on holiday, we can be less in touch with the usual factors of home, work and relationships which help us to regulate our behaviour. A sense of adventure, of freedom from routine compensates for feelings of boredom, disorientation and even loneliness. The ability to make sound decisions about our behaviour can become diminished.

During the course of 2002, the tourist industry in Turkey catered to almost eleven million foreign visitors.

Didim, Summer 2000: a waiter chats excitedly about his engagement to a European girl whom he met a month before when she came for a holiday. They plan to formalise the engagement with a ring when she returns in a few months. He is no more than eighteen years of age and, perhaps, a little naive in his expectation that this was anything more than a holiday ‘fling’. They probably had intimate contact, in which case they hopefully used a condom: owing to the high prevalence of IDUs in the girl’s hometown, she was a potentially high risk sexual partner.

As he talks, a middle-aged tourist at a nearby table is taking a keen interest in another waiter who has brought her coffee. The boy is clearly used to the attention and cheerfully reciprocates her slightly lewd banter.

As rates of immigration, emigration and urbanisation rise, the hazards of casual sexual contact are as real for Turkish travellers abroad as they are at home.

Having completed national service, Selahattin Demirer went to find work in Romania:

I found that the lifestyle was different to where I came from, especially in matters of sex where there was no prejudice … I was young and single and had little experience in sexual matters. I had girlfriends but I was unaware of the dangers (of unprotected sex) so I carried on. If I had known about the danger, things would have been different.

Demirer came home and married. Shortly after his wife gave birth to their daughter, he discovered that he was HIV-positive. His wife proved to be very understanding and supportive. However, during the early stages of his treatment, both she and their daughter also tested HIV-positive. The little girl very quickly fell prey to the debilitating effects of the disease and died. His wife lost hope and refused further treatment for herself. Eventually she too died.

Writing about the common prejudice against sufferers, Demirer says:

It’s important to understand that we don’t have to protect ourselves from people who have this disease, we need to protect ourselves from the disease itself.

In order to inform travellers abroad of the risks, the MOH and UNICEF launched an awareness campaign in 2001. A leaflet entitled Unutmayın is distributed at all passport checkpoints.

Straight Talking

Constituting almost half of the population, children and young people under the age of 25 represent the largest and the most vulnerable social group in Turkey. The average age for a first marriage is rising (currently almost 24 years for men and between 19 and 20 years for women) yet young people are having sex at a much earlier age: a third of men in their late twenties have been sexually active since their eighteenth year.

The need for a comprehensive programme of peer education directed by young people for young people is clear. In the past, UNICEF worked closely with the AIDS Prevention Society in Turkey, promoting peer education in the metropolitan area of İstanbul. Since 2001, activities have been expanded to reach the provinces in collaboration with other NGOs and the Government of Turkey under the Country Programme of Cooperation (CPAP) The ‘Adolescent Health and Development Project’ involves young people in the drive to inform their peers of the hazards.

A ground-breaking brochure using humour to promote the use of condoms was developed and produced by a youth group. A light-hearted approach to the subject successfully ensured that the message would be absorbed by high-school and university students.

Since many children living and/or working on the streets are in danger of being exploited for sex, there is a clear need for concerned agencies to offer counselling, advice and protection from the hazards of infection. Above all, these children need to be sheltered from the dangers of life on the street: they need the safety and security of home and a place in society.

For the first time, HIV/AIDS was included in the primary school curriculum during 2002. Awareness campaigns have featured posters, leaflets and television broadcasts.

Further Action

Since the first case was reported in 1985, United Nations entities such as WHO, UNICEF, UNFPA and UNDP have all played a part in the national response to HIV/AIDS. In 2001, the United Nations Thematic Group (TG) was established. By pooling resources and coordinating the activities of its constituent agencies, the TG aims to raise public awareness and advocates for stronger action by the Government and NGOs. UNICEF has chaired the UNAIDS Thematic Group since 2001. A full time consultant has been commissioned to activate partners within the National AIDS Commission and other concerned institutions.

The ‘United Nations HIV/AIDS Theme Group Situation Analysis of HIV/AIDS in Turkey’ for 2002 estimates that between 7,000 and 14,000 people have been living with AIDS since the start of the pandemic. Figures released by the MOH in June, 2002, show a total of 1,429 reported cases of HIV/AIDS since 1985.

The disparity between the official record and the TGs lowest estimate is puzzling at first but there is a clue in Selahattin Demirer’s words:

This disease is here in our country and it is spreading rapidly because people are frightened of taking the test … and frightened of going for treatment.

If there is any fight against HIV/AIDS, it is not with the retrovirus -- that is a matter of self-protection. The real fight is to educate, inform and counsel against the fear, ignorance and prejudice which puts communities and individuals the world over at risk.

Read the Facts About HIV/AIDS and HIV/AIDS Prevention for Young People. We also took a look at the issue of Teenagers Taking Care in the February 2002 edition of Say Yes.

Many thanks to Selahattin Demirer for permission to quote from his book, HIV’le Yaşamak which is available from Güneş Medical Publishers.

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