Aids advisor on tour in Central America

Hiv/Aids advisor Kirsten Madsen is currently visiting a series of MS programme countries in the South. She has visited East Africa and Central America and will soon be on her way to Mozambique.

”Is this how we fight Aids?”, asks the Danish advisor Kirsten Madsen.

Hiv/aids advisor Kirsten Madsen is currently visiting MS programmes in the South. We asked her about her impressions of the work with Hiv/Aids in Central America.

How did you become interested in Hiv and Aids? 

I began to take in interest in Hiv/Aids in the mid 1980s, among other things because some of my homosexual friends had become infected with hiv. In 1986 I got a job at the aids hotline and since then I have actually worked with Hiv/Aids as a trainer and advisor.

How would you rate Denmark in relation to the fight against Hiv/Aids? 

In comparison with other European countries I would give Denmark a fine rating. Denmark is a very open society in relation to Aids. The government was quick to realize that the epidemic called for open and direct communication, and programmes to ensure access to free syringes were soon launched to contain the risk of infection among drug addicts. In the early years, aids was called the ’gay plague’, but the Danes’ mentality have changed a lot since then. If we take a look at the health sector, we might even say that hiv and aids to a certain extent have worked as a lever in regard to improving communication between hospitals, doctors and patients.

What do you think of the big Aids conferences? 

Many people are sceptical of big conferences, they are expensive, and often people do not understand each other, especially in the case of researchers and activists. Nevertheless, they have been and continue to be platforms where people meet and exchange experiences and strategies in relation to hiv prevention etc. To hold one of them in Durban, South Africa, so to say in the midst of the problem was a good choice. Aids conferences generate a lot of press coverage and they serve to put the epidemic on the political agenda. 

How well is the UN doing in relation to the Aids epidemic? 

The UN was actually quite quick to launch a global programme already in 1986. From the onset, it was realized that this was a global problem which in turn required a global response. The UN itself is a huge and somewhat slow organization, but its collective Hiv/Aids coordination, UNAIDS, is in fact quite user-friendly, if I may say so. They have some well-founded programmes and reports, and somehow UNAIDS attracts pioneers that dedicate their lives to the fight against aids. One such example is the Head of UNAIDS, Peter Piot. 

What is your impression of Aids in Central America?

It is hard to say at this moment. In Guatemala, according to statistics, around 1% of the population is infected, although one must recognize that under-reporting is an issue. The characteristics that one might compare between countries include migration, war, the general situation of women, the human rights record, as well as poverty in a general sense. In Central America, for example, there are a lot of migrant workers. Men are away from their wives and girlfriends for long stretches of time and this has proven to be a risk factor, in other parts of the world as well. 

When we talk about young people, however, I feel that we can make a much more direct comparison. Being young is a particular stage of life no matter where in the world you are. Whether you are in a country with 30% of Hiv-infection or just 1%, the trend is that young people feel young, strong, immortal. Beautiful, but dangerous. We need to get in touch with youth as the epidemic is growing fastest among the 15-24 year olds. Youth peer education programmes are a good point of departure but often the young educators are insufficiently equipped to raise to the challenge. 

A few general comments about communication campaigns?

’Behaviour change communication’ has been a mantra in prevention campaigns for many years, but it is damned hard to change people’s behaviour through big campaigns as behaviour is individual. Campaigns may be very professional from an aesthetical point of view but in practice I don’t think they matter much, and often their reach is limited to the middle classes. Young people are more likely to take their cue from their peers and that is why it is important to engage in direct dialogue with them and raise their levels of knowledge and reflection. You have to get very close in order to discuss behaviour change on a personal level.