Germ warfare

Fran Balkwill and Mic Rolph visit South Africa to trial their new children's book on fighting Aids

Right now I've got a nine year old who is pregnant and HIV positive. Tomorrow I'll need to drop her at the hospital for a termination". Jennifer Bushe, a social worker in the Zevenfontein squatter camp, Johannesburg, South Africa, is describing one of her cases. Most likely this girl is a victim of the widely held superstition that sex with a young child is a cure for Aids. In measured tones Jennifer tells us that between January and June of this year, 38 people in the squatter camp have died of HIVAids. Many more are sick and dying. Lethal viruses normally claim the elderly and very young, but the victims of HIV are usually in their teens and thirties. Of the 40 million people infected in the HIV pandemic, 28 million are African. One in seven of the South African population is now HIV positive - a disaster of unimaginable proportions for a nation just seven years into democracy. The pandemic is at its worst in KwaZulu Natal Province. In some areas 35 per cent of pregnant women test HIV positive, and in the year 2000 more than two thirds of deaths in this population were HIV-related. The senior director of education for the province, Wentworth Dorkin, tells us that twice as many teachers die between the age of 30 and 35 as in any other age group. He can spend whole days dealing with paperwork for teachers too ill to work.

We are in South Africa to trial our children's book, Staying Alive Fighting HIVAids. The project began two years ago when South African-born Professor Siamon Gordon of the University of Oxford asked designerillustrator Mic Rolph and myself if we could write a children's book on HIVAids. Although our previous science books have been published internationally, we felt uncomfortable outsiders with this topic. We needed to do some research.

In April 2001, Mic and I visited KwaZulu Natal and Gauteng provinces in South Africa to seek advice from students, teachers and health professionals. We stressed that we came to learn as well as help, and that we wanted to complement existing initiatives. Most importantly we asked children what they would like us to include in the book. Whether we talked to Zulus in Mtubatuba or Afrikaners in Pretoria the suggestions and questions were the same. By the end of this first visit, we knew what to include. Although our book would be a resource for teachers, we felt it should primarily be for children to take into their homes. Our publisher, Cold Spring Harbor Laboratory Press, New York, agreed to produce the book at cost and we had funding for a pilot print run of 20,000 books. Our approach was to use a combination of stylised illustrations with a minimum of words. Mic also used drawings that the South African children had produced for him. The book begins with viruses and bacteria and the cells that fight such germs. We discuss the origins of HIV, why the virus is so dangerous and how it actually makes people ill. An important section covers ways of catching HIV, as children had told us of their confusion about this. We then talk about prevention and ways of negotiating sexual relationships and include one of the mainstream prevention messages, ABC (Abstinence, Be faithful, Condomise). We stress the importance of caring for people who live with the virus; current treatments (still a remote possibility for many sufferers in Africa) and prospects (remote for the whole world at the moment) for a preventative vaccine.

By June, 20,000 copies of the 32-page children's paperback were on their way to Cape Town and three book launches were organised in Johannesburg, Mtubatuba and Cape Town with key organisations involved in the HIVAids struggle to ensure maximum collaboration. Especially important to us were the comments of prominent HIV positive individuals and support from South Africa's education minister Kader Asmal. In Mtubatuba in KwaZulu Natal, the Africa Centre for Population Studies and Reproductive Health organised a two-hour launch ceremony. About 200 school principals, health professionals and journalists were entertained with gospel music, speeches and Zulu dancing from the children of nearby Qalakancane school. A youth drama group staged a play of the book, dramatising the way natural killer cells and macrophages fight infections.

We found some excellent material on HIVAids in the South African Life Skills curriculum for Grade 4 and 5 (age 12-14), but little in the science curriculum on viruses and bacteria, let alone HIV. We have to assess the need for translations in other African languages such as Xhosa, Zulu, Afrikaans and Sotho, and for a teacher's information pack.

South African teachers are in the front line of the HIV pandemic. They see colleagues, family, friends and their pupils sicken and die and they fear for their own health. In many schools, teachers who die of HIVAids are not replaced.

We began to receive requests for books from such diverse groups as Catholic nuns, traditional healers, football clubs, counsellors, social workers and nurses. The demand greatly exceeds the supply and our next goal is to obtain enough funding from charitable foundations in the US or UK to produce a million books or more for children all over the world.

We left South Africa with a sense of hope. We met some truly remarkable, inspiring and dedicated people: Zulu boys who changed the words of a traditional song to extol the virtues of condoms; volunteers who run self help groups in squatter camps and townships; HIV positive women who train lay counsellors and co-ordinate the memory box projects; teachers who travel under difficult and often dangerous conditions to attend workshops and seminars on HIVAids; youth drama groups in townships and rural areas. We found a widespread acceptance in all sectors of society of HIV as the cause of Aids. A growing number of people, but still far too few, have access to anti-retroviral drugs accompanied by nutritional support. But the best way to stop this devastating disease must be to empower young people with the knowledge and confidence to say 'NO' to unprotected sex. As the South African Minister of Education, Kader Asmal, said: "In the absence of a cure, education has to be the social vaccine".

Fran Balkwill Illustrations are from Staying Alive Fighting HIVAids by Fran Balkwill and Mic Rolph, which is not yet available in the UKEmail: balkwill@cancer.org.uk

Fran Balkwill is professor of cancer biology at Bart's and the London Queen Mary's Medical School and author of Cells are Us (HarperCollins) and the Making Sense of Science series (Portland Press)

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