DOUALA, CAMEROON – A lot has changed since Dr. Elizabeth Fon Fonong began working as a doctor in Douala, the capital of Cameroon’s Littoral region, almost 30 years ago.
“When I started work in 1985 as a young medical doctor, HIV/AIDS was some scary, new disease that we had to deal with,” Fon says. “The first AIDS patient was a curiosity that drew all the doctors in our Laquintinie Hospital to take turns observing her.”
Later, as the number of HIV and AIDS cases continued to grow, Fon says she began educating the population with the ABC prevention message: A for abstinence, B for be faithful and C for condoms.
“We learned to pass on the ABC of HIV prevention to the population, and evaluation tests revealed that the population could parrot all the right answers at the end of our various workshops,” she says.
But the infection rate did not slow in reflection of this increased knowledge, Fon says. She and her husband were stumped by one common question:
“Why is it that almost everyone who has attended a workshop or listened to a radio or TV message on HIV prevention can pass a written or oral examination on the subject, but this knowledge is not translated into effective HIV prevention in their marriages or cohabiting relationships?” she recounts.
So she started talking and listening to the patients about their stories of HIV transmission in marriage. After hundreds of hours of brainstorming with friends, patients, and married and unmarried people, she and her budding team conceived the TESHO – TE for Team, S for Spirit, HO for Holistic – concept to promote practical techniques to live the ABC principles.
They tested the modules with patients and others. After obtaining positive feedback from those they counseled, they decided to go public with the method in 2006.
Fon is currently the regional coordinator of the 35 government health centers that care for people suffering from tuberculosis and HIV and AIDS in Littoral. But she is most proud of her title as founder and chief executive officer of TESHO, a foundation she established to educate and counsel people on this strategy.
She and her husband now view their 27-year marriage, governed by TESHO principles, as a precious gift from God that they need to share with other families.
The foundation disseminates the TESHO program through several methods, including interactive workshops and one-on-one counseling sessions. It translates the ABC approach to HIV prevention from theory into applicable techniques.
The Cameroonian public knows its ABCs when it comes to HIV prevention, but trends show people aren’t putting the approach into practice. So one local doctor has developed a program to impart life skills in order to drive behavioral change. Other health professionals say the fresh strategy could reduce HIV transmission.
Fon says there was one HIV-positive patient in 1985 in Cameroon's Littoral region, where the population was approximately 1.35 million, according to the Ministry of Economy, Planning and Regional Development’s 1987 census.
The number of HIV-positive pateints grew to 133,400 by 2011, with a HIV prevalence rate of 4.6 percent in Littoral, where the population had grown to 2.9 million inhabitants, according to the National Institute of Statistics. The national HIV prevalence rate is 4.3 percent.
Yet a Catholic Relief Services 2009 Study on Population and HIV Knowledge revealed that more than 90 percent of the Cameroonian population had given the right answers to questions about methods of HIV prevention, Fon says.
The traditional ABC approach to HIV prevention has been around for more than 25 years, Fon says. It offered hope to a population that had previously received scary slogans such as, “Beware, AIDS Kills!”
The ABC prevention methods are fundamental and constitute the theoretical principles of HIV prevention, Fon says. But despite the efforts of medical personnel and the population’s knowledge of the ABC approach, it hasn’t inspired a change in behavior.
“The population readily learned the ABC messages and could rattle them off like a primary school child parroting his A, B and C’s,” she says. “After all these years, we are waking up to realize that the ABC approach is easier recited than actually put into practice by the population.”
The ABC method can be helpful in reducing the HIV infection rate, she says. But each principle poses challenges, ranging from temptations to have sex before marriage to controversies surrounding the use of contraceptives.
The TESHO program aims to equip people with life skills to overcome these challenges so that they can effectively put the ABC knowledge into use in their relationships.
Going by the program’s motto, "Getting Real, Working Together to Succeed," Fon and her colleagues insist that HIV prevention has to start with the TE – teamwork – for the ABC principles to be effective.
Fon says parents yearn for their children to choose and effectively practice A for abstinence.
“However, they have not even learned how to discuss sexuality with their teenagers,” she says of parents. “The subject of sex is taboo in our context.”
Fon says that the TESHO adolescent modules can teach teenagers and parents effective communication skills to replace scolding or awkwardness with positive discussion.
“Talking to a teenager out of the blue about sexuality can lead to disaster,” she says.
As for B – be faithful – the TESHO program teaches participants simple life skills to resolve threats to their fidelity, such as verbal and nonverbal communication skills. Participants learn about words that heal and words that destroy, communication mistakes and sincere apologies that come from the heart.
TESHO workshops are effective for couples having difficulties in their relationships or marriages, Fon says.
Beatrice Bwemba, a 35-year-old hair stylist, has attended several TESHO workshops in Douala.
When problems in her marriage, such as a lack of understanding, dialogue and affection, became overwhelming, she contacted Fon. She says that Fon encouraged her that she could change the situation with her husband using life skills taught during the workshops.
Within six months, Bwemba says the skills she applied, such as learning to be more patient and using teamwork to build trust, allowed her to increase her confidence and reconnect with her husband.
“When there is team spirit in the home, you would always want to be with your partner, and this would reduce the risks of HIV,” says Bwemba, who has been married for 16 years.
She credits TESHO for the change.
“I never knew that I would be in this wonderful moment now in my marriage, because at first, I wanted to leave my husband since I had so many problems,” Bwemba says.
Fon says that advocating for the third component of the ABC approach – condoms – is useless without teamwork. Teamwork enables couples to resolve issues such as persuading one’s partner to use condoms or finding another option if he or she refuses.
Fon counsels couples that female condoms are also an option.
Although the community has accepted male condoms more widely, the price of female condoms and the limited number of women openly using them hinder their popularity, says Annette Enibi, a psycho-social counselor, peer educator and member of the Association des Personnes Affectées par le Sida, which brings together people living with HIV and AIDS as well as their relatives.
“If the male condom wasn’t easily accepted, even the female ones cannot be accepted easily,” she says. “But there are many women using it, though in hiding.”
Enibi visits markets and neighborhoods to sensitize people on the proper use of female condoms. She says men sometimes see female condoms as a hindrance to their relationship, but she emphasizes that female condoms liberate men and protect both men and women.
Dr. Fergus Ambe, an immunologist at the Yaoundé Central Hospital, which treats patients with HIV and AIDS in the nation’s capital, Yaoundé, says the ABC method is still in use because it represents healthy living. Ambe says it’s important to stand by these traditional methods, but he is also open to using new techniques to implement them such as TESHO.
“Certainly, those are all healthy tips,” Ambe says of the TESHO strategy. “If we could adopt such approaches, it could even stop the spread of HIV.”
Ambe says that promoting healthy lifestyles is paramount for the well-being of the country.
“As much as we can encourage people to use these principles, we should be able to encourage them to live a healthy life,” he says. “A healthy life would mean to be able to take into consideration the need to stick to one partner, to abstain if not married.”
Fon says that TESHO program may not be a replacement of the traditional approach to HIV prevention, but it can make it more effective.
“I can write a whole book on TESHO success stories,” she says.
