Author: David R Patient, April 7 2014 Ever stopped to wonder why we, in HIV prevention, have spent years teaching people about HIV, prevention and ARV's [antiretroviral therapy] and yet people still revert to their cultural/religious/traditional beliefs? I mean there is no concrete evidence that the Ancestors exist, right? There is little evidence that traditional medicines work, yet people believe in them. The same can be said (in some circles) that the existence of Greater Power is questionable, yet so many blindly believe in such an entity. So people operate on blind faith, with no tangible evidence. And along we come, with all our western medicine and scientific approach to prevention and germ theory and at the end of the day, we are asking people to take on what we are saying, as an act of blind faith. How is it any different from what they already believe in, blindly?
Let me prove my point...
A few weeks ago we were working with a team of HIV prevention community workers in a small rural town in Limpopo Province, South Africa. We were having a conversation around secret cultural practices within the context of germ theory and transmission of HIV. When we started to get into Langerhans cells and modes of transmission, our contribution was met with a fair amount of skepticism, yet we were teaching scientific facts! Then it dawned on us, an epiphany if you will, that we were asking people to trade one set of blind faith beliefs for another. They had never seen the Ancestors, yet believed in them. They had never seen The Higher Power, yet they believed in the existence of one; and now we were asking them to blindly believe that there were these things called germs, and expected, without providing evidence, for them to simply accept what we were teaching at face value and to shift their paradigms to 'our scientific' way of thinking.
Our experience is that most people have never been exposed to even the most basics of how the human body works; their reproduction system and the basics of germ theory. Not their fault; purely circumstantial as they were never taught it in their schools. The vast majority of the South African population is clueless about their bodies.
So we decided to do an exercise. As luck would have it, we were in a clinical setting so we arranged an electronic microscope to be brought into the training room and placed a sputum sample on a slide, lined it up under the microscope and let people look at it. There was not one person in the entire group that did not get blown away by what they saw in that microscopic world represented in the sputum sample.
For the very first time in their lives, they saw a world that had been, up until that moment, a world they were being asked to blindly believe in. For the first time ever for this group, we could prove the existence of the world of germs. You have no idea the profound effect that simple exercise had on these people. What was once something they followed with blind faith was now factual and undeniable...no longer faith, but evidence based facts! This simple exercise has, over the past few weeks, changes that entire organization and the way in which they approach the communities they serves.
All too often, program designers of prevention processes make the assumption that people know and understand how their bodies work, the basics of the immune system and the fundamentals of germ theory and launch their interventions at a group of people who lack the basic understanding of any of it. Then they expect people to shift their blind faith from one set of beliefs to another, when they lack the foundation to base it on. And we wonder why people don't adhere to their medications; why they don't worry about transmission; why they don't see the importance of treating co-infections and why so many do not believe in the existence of HIV or feel it is a curse or a bewitchment or the anger of God or the Ancestors? Until we can prove, in a very real way, by showing, not just telling and explaining, people are going to push back and revert to the blind faith beliefs they have in place already and nothing will change.
We need to take a few steps backwards, taking time to put the basics in place before we rush in and present our prevention interventions. It's a bit slower than most of us would like, yet in order for our intervention to work more effectively, we need to create the foundation on which to build peoples understanding of the scientific facts. We can no longer expect people to blindly believe in what we know to be science, because for most, it's just another act of faith if we do not provide the evidence.