Notes From The Margin

June 30, 2007

Good News About the Fight on AIDS….

Filed under: AIDS,Barbados,Health Care,HIV — notesfromthemargin @ 1:51 am

Today some good news arrived on Radio about the continuing fight against HIV/AIDS. In case you didn’t know Barbados has been hailed as a success in it’s response to HIV/AIDS. In fact we have been hailed as a model case.

“I was a bit wowed by the degree to which Barbados has truly institutionalized a multi-sector approach to addressing HIV/AIDS. You are not only a role model for the Caribbean, truly and honestly Barbados is a global role model. [I’ve] worked on HIV/AIDS in several countries in the former Soviet Union, south Asia and East Africa … Barbados has surpassed all. In fact, Barbados has surpassed US and western European efforts in this area!”
Rebecca J. Rohrer, Director, USAID HIV/AIDS, Caribbean Regional Program (2003)

The Barbados response has resulted in huge drops in HIV mortality. (In English that means that people with HIV survive longer). Our major problem is that while people with HIV/AIDS have been living longer, we have thus far been unable to reduce the rate of new infection.  That is: people continue to get AIDS at the same rate as before and live longer once they have it.  You don’t have to be a genius to see how this can come off the rails in the future.



Today for the first time ever Dr. Carol Jacobs announced that in one age group we logged a decrease in the rate of infection. The news isn’t much, it’s only one age group and its only for one survey. But it is a sign that maybe, just maybe. We can get a grip on this disease that threatens our future.



The National AIDS Commsion has taken a lot of heat over their ads, by people who have been offended by the content or the implied content of the ads. In my opinion it might be a good idea if the critics would back off and let the professionals do their work. The cost of failure  on this is just too high.





  1. Hi Marginal:

    I am one of those persons who disagree with the Commission’s approach. Perhaps you can understand my concern through my ‘letter to the editor’ that was published last week.

    The HIV/AIDS Commission has correctly identified behavioural change as the principal solution to the AIDS pandemic. However, I am gravely concerned about their strategy to achieve such change.

    I would have thought that in seeking to bring about behavioural change, that they would have encouraged responsible behaviour. If a section of the audience then chose to act irresponsibly, then an alternate strategy could have been found to protect others from their irresponsible behaviour.

    An exemplar message could have been: “Abstain from sexual intercourse until marriage, and when you are married, be faithful to your spouse. If you choose to engage in sexual intercourse before you marry, or if you choose to be unfaithful to your spouse, then please protect your future or current spouse by wearing a condom.”

    This concept of: “Do right, but if you choose to do wrong, then mitigate the consequential damage” can be packaged to the various at-risk groups in order to achieve the goal of behavioural change. However, the commission appears to have followed the concept of: “Do wrong and mitigate the consequential damage. If you think that you are one of those rare individuals that can abstain or remain faithful to your spouse, then go ahead.”

    For years, many persons have tried to encourage the Commission to promote the more responsible “do right” rather than the “do wrong” approach; however, the Commission appears to have responded by promoting even more irresponsible behaviour through their advertisements. It is time to ask the Commission to clearly define the type of behavioural change that they are trying to bring about. The assumption was that it is the responsible type, but the evidence suggests otherwise.

    Grenville Phillips II

    Comment by Researching — July 2, 2007 @ 8:48 pm | Reply

  2. Hi Grenville,

    some would argue that the approach outlined above (the “do right” approach) takes an implicit judgmental position that may reduce the effectiveness of the message. I would be curious to hear from someone on the effectiveness of the campaigns that promote the “do right” approach.


    Comment by notesfromthemargin — July 3, 2007 @ 6:43 pm | Reply

  3. Hi Marginal:

    I believe that the most successful national behavioural change strategy was Uganda’s. This followed the responsible “do right” model of first promoting abstinence and faithfulness, and then condom use.

    The current strategy employed by the Commission has, to my knowledge, never worked anywhere at any time in recorded history. Actually, it has consistently failed every time and everywhere it has been implemented!

    Given the terrible consequences to our nation and the region, the time has come to ask the Commission why they are persisting with this tried and failed irresponsible approach.


    Comment by Researching — July 4, 2007 @ 10:07 pm | Reply

  4. […] Churches of Barbados have declared a “War On AIDS“. Over at the Barbados blog “Notes From The Margin“ they are already celebrating victory in a manner worthy of a government news […]

    Pingback by SCANDAL! - Barbados “War On AIDS” - How Owen Arthur And His Government Refused The Donation Of A Free AIDS & Cancer Hospice « Barbados Free Press — July 7, 2007 @ 3:26 am | Reply

  5. Posted on Barbados Free Press in response to the article which used the post.

    July 9th, 2007 at 1:02 am

    Seeing that my blog was quoted here (or rather quoted out of context) I’ll respond. If you chose to visit NotesFromTheMargin, you would see that far from celebrating any “victory” the post notes what is really the first positive sign EVER that we MIGHT have a chance of avoiding the abyss.

    Barbados has recorded remarkable drops in AIDS mortality (scientific fact not open to political dispute) however has up to this point been completely unable have any success in reducing the rate of infection. (also not open to dispute)

    The post talks about the first evidence of a reduction in the rate of infection. Which if anything gives hope for the future. BFP chooses to use the post completely out of context.

    Should you wish to see the full article you are welcome to check out


    Comment by notesfromthemargin — July 9, 2007 @ 1:05 am | Reply

  6. Hi Marginal:

    Just one last bit of clarification to the two separate HIV/AIDS issues. You correctly identified both of them: mortality rates and infection rates.

    You also correctly identified that Barbados’ enviable success was in reducing the mortality rates, not the rate of infections.

    Please be advised that the mortality rates have been reducing as a result of the research and other work of the Ministry of Health’s Ladymeade Reference Unit, and not the HIV/AIDS Commission.

    The Commission is responsible for the irresponsible “do wrong” advertisement campaign which has not worked and should not be confused with the success in reducing mortality rates. I suggest that your charge that the “critics” should “back off and let the professionals do their work” needs to be revisited. As far as I am aware, the professionals at the Ladymeade Reference Unit have no critics.

    My question then is: In your opinion, how much longer should we allow the Commission to continue with their irresponsible approach before we can critically analyze their strategy? They have already had 6 years without success.


    Comment by Researching — July 9, 2007 @ 3:05 pm | Reply

  7. Grenville,

    You certainly have provided food for thought in your post. I’ve looked at the material on Uganda’s programme, and its success rates. The programme does give hope for the future that the train can be turned around. However it is plain that the situation is not an “either/or” question. The social marketing of condoms was an explicit part of the Uganda campaign as was an effort to promote fidelity and delaying sexual activity.

    I’m not taking up a position here to defend the NHAC no matter what, my view is whatever is working let’s do it. The consequences of being wrong are too terrible to contemplate. I don’t think however that attempting to advocate abstinence to an already sexually active 22 year old that is not in a committed relationship is going to work either.

    For some interesting info on the Uganda programme readers can check out this link it truly is an amazing success story.

    Comment by notesfromthemargin — July 10, 2007 @ 2:31 am | Reply

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