Kicking AIDS Out of Africa

This is a lesson in fidelity. The B in the ABCs of avoiding AIDS: Abstain. Be faithful. Condomize.

On a dusty scrap of land in the Zambian capital of Lusaka, two lines of teens stand poised. They’re taking part in a program run by Grassroot Soccer, a nonprofit founded in 2002 that uses soccer-inspired events and activities to educate communities across southern Africa about the perils of HIV. The first group of teens has to dribble a ball 30 yards before weaving through a series of cones—all without being caught by the second group. In this exercise in faithfulness, the ball represents a sexual partner and the second group of teens, HIV.

Defending a single ball, or partner, from the potentially deadly virus is easyfor most—the first line of teens even has a ten-second head start—but the drill gets trickier. Next time they have to make it with two balls, then three.HIV catches up.

In Zambia, HIV often does. According to UNICEF, more than 15 percent of adults have the retrovirus (compare that to 0.6 percent in the U.S.), while the CIA World Factbook estimates that 56,000 Zambians die every year from AIDS. Young women are hit disproportionately hard—prevalence of the virus is nearly four times higher among female 15- to 24-year-olds than it is for males of the same age.

“HIV and AIDS in Zambia don’t just alter the entire life of the individual who is positive; they have the potential to unravel much of the fabric of Zambian society,” says Mike Zales (SAR’08, SPH’10), a monitoring and evaluation advisor with Grassroot Soccer. “The Zambian people are very community-oriented, but due to the nature of viral transmission—and the harmful myths surrounding HIV-positive people—stigma and discrimination still run rampant.”

Zales has been in Africa with Grassroot Soccer since 2009, first in South Africa, now in Zambia, and helped perfect the exercise in fidelity, Breakaway from HIV. From his base in the Zambian capital, Zales pilots and measures the success of the nongovernmental organization’s programs, including HIV-testing events—run in tandem with community soccer tournaments—and its flagship prevention curriculum, Skillz.

“We hope that Grassroot Soccer not only educates young men and women about HIV, but also offers them a skill set for living HIV-free or for startinga new life if they’re found to be HIV-positive,” says Zales, who’s also working on education projects in two refugee camps and—in his down time—providing expert advice on maintaining patient records to a small pediatric HIV clinic. “Evidence shows that knowledge alone will not defeat HIV, but positive peer relationships, evolving gender norms, and community support and activism give us a multidimensional approach to combating the virus,” he adds.

Offered at weeklong camps and in eight 45-minute sessions in schools and communities, Skillz mixes traditional classroom learning with group discussions and on-field activities, including Breakaway from HIV. Zales monitors everyone who takes part with pre- and post-participation surveys to “see how attitudes, knowledge, and communication regarding HIV have changed.” He’s also halfway through a two-year survey of 3,200 Zambian youth. The goal is to get a nationwide baseline that will help him compare “testing practices, sexual behavior, and sexual debut” between those who’ve taken part in the soccer-based programs and the rest of the population.

Zales expects the figures to show a positive impact. In neighboring Zimbabwe, where research on the program is more established, graduates were four times less likely than those who didn’t take part to have engaged in sexual activity and eight times less likely to have had multiple sexual partners.

It’s those kinds of numbers that first got Zales interested in Grassroot Soccer’s work. He started following the organization as part of a research project for Sargent College’s Introduction to International Health course and liked that it was “pretty strictly monitored and evaluated—a lot of these programs are not.” Impressed, he later applied for an internship with the organization; after a successful six-month stint, he was asked to stay on and continue his work.

Now a full-time employee with “medical school on my horizon,” Zales says it’s an added bonus that his work allows him to tie the health policy research with frontline services: “We’re linking kids who test positive at our events directly into treatment and care, bridging that gap where people are usually lost on follow-up after testing. There are very few programs I know of that are providing that linkage.”

A key part of Grassroot Soccer’s success, says Zales, is its use of community role models and volunteers. Westerners like him are employed only in training and support roles; locals lead the lessons and soccer camps.

“It’s really locally based, locally run,” he says. “We’re invested in the community—we run focus groups, trying to gain the trust of the community first, before going in and trying to change the way things are done.”

Even with local backing, Zambians can be a tough sell. Zales describes the culture as “pretty conservative.” Around 25 percent of the population is Roman Catholic, restricting the reach of ‘C’—condomize. But he says the country’s younger generation is beginning to reject old attitudes toward the virus and its prevention: “A lot of people in the compounds we work in, high-density urban areas, are curious to find out why so many people in that core age range of 25 to 45 are dying. They’re not willing to accept it.”

The soccer helps, too. Zales has traveled widely in southern Africa, from Tanzania down. Everywhere he’s been, someone has been kicking a ball.

“It’s an easy way to relate to people across all countries, all borders, all languages, because you can share something in common,” he says of the world’s favorite sport. “It’s a great community mobilization tool and that’s what Grassroot Soccer has done, it’s found a way to relate to communities half a world away.”

For a soccer-loving kid from New Jersey, talking “football” comes naturally. And, as a bonus, a very big bonus, he got to work in South Africa during the 2010 World Cup.Thanks to a corporate sponsor, Grassroot Soccer was given 10,000 game tickets for kids who’d been through its programs. Aside from helping the organization “get out on a global scale” (it was suddenly hot property for reporters from media outlets like GQ and The New York Times), Zales says the event gave him memories to last a lifetime: Some of the children he escorted had “never even been to a soccer match before,” others had “never really seen grass before.”

Now those kids—freshly armed with the ABCs of AIDS prevention—have a great chance of outlasting his memories.

Andrew Thurston can be reached at thurston@bu.edu.

A version of this article originally appeared in the 2011 edition of Sargent College’s Impact magazine.