Yet sexual health education is now proven to be effective in reducing infection risks - especially among young people, who can adopt safer behaviour from the start of their sexual lives. In countries such as Uganda and Tanzania, dramatic declines in infection rates among teenagers are now being recorded following successful condom promotion and AIDS education campaigns in school and in the community. Overcoming silence and denial Southern Africa can also point to successful initiatives in prevention, care and support. Prevention efforts in the workplace are not only effective, they are also cost-effective. But the shame associated with AIDS continues to blocks progress by making people reluctant to talk about HIV, recognize the risks and confront the epidemic openly.
Political leaders can be slow to acknowledge the threat facing their country.
Ordinary citizens may hesitate to raise the issue of condom use with their spouse for fear of acknowledging HIV infection. For example, when voluntary counselling and HIV testing were offered to pregnant women in South Africa's Soweto, almost all accepted testing, four-fifths overall returned to find out their HIV status, but only half of those who tested positive came back for their test results. The visible causes of illness in severely immunodeficient people are often diseases such as tuberculosis and pneumonia which are also common in HIV-negative individuals. Because of this unusual feature of AIDS, the silence that surrounds the epidemic can persist even when AIDS patients are ill and dying. A recent study in southern Africa showed that fewer than 1 in 10 people caring for an HIV-infected relative at home acknowledged that the person was suffering from AIDS, and the patients themselves were only marginally more likely to speak about the underlying cause of their illness.