As country steering committee member for the development of the NSP, Dr Ahluwalia is committed to the success of the plan but states that the new NSP cannot be implemented through a “top down” approach.
“Instead, we need to begin at the micro level, with individual families,” Dr Ahluwalia stated. A recent study of family-level interventions, published in AIDS Care, found that participants were ‘highly motivated’ and receptive to these interventions.*
“By creating HIV prevention champions within families, we can achieve a far more radical reduction in infection rates. People aremuch more likely to be receptive to conversations about private topics like sex and health with family members than with strangers,” he continued.
Dr Ahluwalia poses that the most efficient and effective way to reach millions of households is to empower the students in higher education institutions. “Students are the most suitable candidates to bring about this change as they are well educated, motivated and articulate. These students are usually the only ones in their extended family able to attend such an institution, and their relatives often rely on them for financial support once they graduate and begin earning a salary,” he says.
In 2015, a Mail & Guardian report found that young black professionals often support as many as 14 relatives with their salary.** This phenomenon, known as ‘black tax’, is usually viewed in a negative light, but it puts these young people in an unusual position of influence within their extended families.
“As the main breadwinner for a family, they can exert more influence over family affairs than their age might normally imply. If we make these young people the champions against HIV, they become a lever that can shift the direction of our entire country,” says Dr Ahluwalia.
“I am often asked about the prevalence of HIV at our tertiary institutions, which is lower than the general national HIV prevalence, and I always reply that we cannot afford to lose even one of these students. A student that contracts HIV and dies before the age of 30 leaves their family without a primary breadwinner. If we do not empower our students, we risk condemning their families to another generation of poverty,” he says.
Peer education programmes
Dr Ahluwalia states that the most effective way to recruit and train anti-HIV champions is to use a peer education approach. An extensive review of published studies by Advocates For Youth found that it is “beyond question that peer programmes can have statistically significant effects on attitudes, norms, knowledge, behaviours, and health and achievement outcomes.”***
HEAIDS has recruited and trained 12 000 peer educators throughout South Africa’s tertiary education system. These dedicated young people work with their fellow students to educate and support each other in combating the epidemic.
Part of each peer educator’s mandate is to recruit 100 other HIV-prevention advocates at their institutions. The result will be over a million educated young people dedicated to eradicating HIV in our country. These are the foot soldiers in the war against HIV.
“Critics of the NSP have pointed to the mounting burden on our healthcare system, and a shortage of the resources required to substantially increase our efforts to combat the epidemic. The ‘bottom up’ approach that I’m advocating would both mitigate the former problem and alleviate the latter,” Dr Ahluwalia continued.
“If we make our best and brightest young people the champions against HIV, we provide them with the tools to change their families and to live long and productive lives. We break the cycle of poverty and dependence for millions of people. There can be no better investment in the fight against HIV,” he concluded.