Tuzan Village, Grand Gedeh County, Liberia - On the stoop of a gray mud house near the center of this lush farming village, Jessica Quarles pulls aside adolescent boys and young women, one by one, to get their thoughts on the biggest public-health risk to their generation.
What do you know about AIDS? How do you think it is spread? What do your friends say about HIV/AIDS? Who do you trust to tell you correct information?
Quarles, Mercy Corps' Portland-based HIV/AIDS program officer, is trying to gauge the effectiveness of the agency's current curriculum and measure local receptiveness to a future program that will meld HIV/AIDS education and soccer.
The one-on-one interviews also give Quarles an opportunity to spread the messages she wants every Liberian to know: Yes, AIDS is a terminal illness. But it's preventable. And it's possible to live well for several years with HIV.
Together, those messages constitute a nearly 180-degree turn from the more common, fear-based message "AIDS kills." Quarles cringes when she hears the phrase. It stigmatizes and isolates those who are living with HIV, she says, and creates a powerful disincentive for learning about the disease and acting on that knowledge, whether it's comforting an infected friend or practicing safe sex.
"We know from decades of experience that fear-based messages don't work, particularly with adolescents," says Quarles. To her, the ideal AIDS awareness program should present unbiased facts about the disease, forcefully debunk its many myths and strike a hopeful tone. "If you allow young people to make choices based on impartial information, they tend to choose healthier options."
A cause for justice
Quarles, a slender, affable woman who speaks passionately and articulately about HIV/AIDS both to roomfuls of people and in private chats, attributes her initial attraction to AIDS to her fervor for social justice. After graduating in 1996 with a psychology degree from Connecticut's Wesleyan University, Quarles moved back near her family home in suburban Maryland and landed a Tuesday-through-Saturday job in the post-production studio of the NBC drama "Homicide."
But on Mondays, rather than relax, she volunteered at Washington's Whitman-Walker Clinic, one of the nation's oldest sexually transmitted disease clinics for gays and lesbians and a front-line responder to the capital's growing HIV/AIDS epidemic. Practitioners there, she recalls, treated patients as "whole people" and imbued their work with a strong sense of social activism. "I saw them addressing not only a medical issue, but also issues of inclusion and exclusion that are at the foundation of our social and economic disparities," she explains. Quarles had found her calling.
From there, she landed an AmeriCorps job counseling families at a pediatric AIDS clinic, where she learned an abiding lesson: those who dealt forthrightly with an HIV diagnosis were almost always better off than those who didn't. "It showed me that when we address AIDS head-on, positive things can happen."
After earning a master's in public health at Columbia University, Quarles spent three years running an award-winning AIDS program for rural youth in Lesotho, the small, mountainous kingdom surrounded by South Africa. The experience forever endeared her to the plight of Africans fighting the AIDS pandemic.
Back to Africa with Mercy Corps
Eighteen months after leaving Lesotho, Quarles marked her return to the continent in Liberia, an impoverished country reeling from a quarter-century of tyranny, anarchy and civil war. Its economy centers largely on subsistence farming and most of its people can neither read nor write. Even the capital city of Monrovia lacks electricity and running water.
Accurate demographic statistics are nearly impossible to come by, but UNICEF estimates that 8.2 percent of Liberians have HIV. That's only a point higher than the average rate for sub-Saharan Africa, but a September report released by the agency warned that current social and economic post-conflict conditions "favor the rapid spread" of the disease.
The spread of AIDS, in Liberia and other developing countries where Mercy Corps works, threatens to derail efforts to improve food security, fight poverty and stimulate economic growth. That's why the agency hired Quarles last January to be its first HIV/AIDS officer, and stepped up its efforts to integrate HIV/AIDS into existing community-development programs.
In Liberia, that meant piggybacking on the five-month youth curriculum known as YES, for Youth Empowerment for Life Skills. The three-day HIV/AIDS module, now in place in 150 villages, teaches young people - roughly those between the ages of 18 and 30 - about the major transmission routes of HIV, ways to protect themselves from infection and how to separate fact from myth.
Mercy Corps HIV/AIDS programs currently reach more than 265,000 people worldwide, including AIDS orphans in Zimbabwe, tea workers in India, indigenous farmers in Guatemala and Honduras and HIV-infected city dwellers in Uzbekistan. That number includes 3,000 Liberians who will be the first to help Mercy Corps test a new approach to HIV/AIDS education.
Mercy Corps is teaming up with athletic-apparel giant Nike and Grassroot Soccer, a three-year-old U.S. nonprofit that trains local soccer players how to talk to kids about HIV prevention. Nike, which sends free footwear and apparel to Mercy Corps youth programs in places like Central Asia and the Middle East, is outfitting all 3,000 participants with jerseys, shorts and shoes, and providing 400 soccer balls. Grassroot Soccer will try to turn on-the-field idols into classroom teachers using a curriculum that's been favorably reviewed by a research affiliate of Stanford University.
Quarles hopes the Grassroot Soccer model, enhanced by the incentive of Nike equipment, will reinforce what some have learned in YES classes and draw more at-risk youth into the fold.
A firsthand assessment
Grand Gedeh may be the ideal testing ground for a new approach. In many ways, it mirrors Liberia's woes. Most of its 100,000 residents live in mud homes roofed with palm fronds or corrugated zinc and survive on food rations from the UN's World Food Program. Despite the assistance, two out of every five children showed signs of stunted growth in a recent survey. The humanitarian agency Medicines Sans Frontieres runs county's only hospital, in the capital city of Zwedru, and lists malaria, respiratory tract infections, measles, anaemia, ulcers and complications during childbirth as "persistent health problems."
After a two-hour flight from Monrovia to Zwedru on a small UN propeller plane, Quarles and three other Monrovia-based staff make their way to the village of Tuzan. The two-hour, four-times-a-week YES sessions are so popular here that a “viewing area” was set up for youth who couldn't find a spot inside the small hut that serves as the classroom.
After greeting the elders, Quarles and Michael Doe, a Mercy Corps YES program officer, rounded up about a dozen men, aged 14 to 25, who were just back from a day spent picking rice and hunting bush meat. In a canvas tent, Quarles asked them about YES and its impact on the community. Then, in one-on-one meetings outside, she surveyed them on their AIDS knowledge.
What she found was that youth held some of the common misconceptions about AIDS, such as that it came only from neighboring Cote D'Ivoire or was spread by dog bites. Although they could recite basic education messages they'd seen on roadside billboards or heard on the radio - about condom use and monogamy, for example - they didn't necessarily act on them.
"A lot of youth are in the 'confirmation stage,' where they have the basic HIV/AIDS information but haven't decided whether to believe it or incorporate it into their lives," explains Quarles. "One of the ideas behind Grassroot Soccer is using role models who young people trust - like football players and coaches - to confirm what they're hearing about AIDS and integrate it into their behavior."
An opportune moment for Liberia
Now may be the perfect time for young Liberians to hear a more hopeful AIDS message. Until now, the fatalistic "AIDS kills" mantra has played well with a population under siege. Liberia's 14-year civil war, which ended in 2003, claimed an estimated 200,000 lives - an appalling toll for a country of only three million. Many Liberians told Quarles about a popular wartime saying that goes, The disease that will kill you has no cure. "It means everybody dies, so there is nothing you can do," she says.
Those attitudes are changing. In the wake of the country's first post-war elections, Liberians appear eager to return to work, school and other normal rhythms of life. That's especially good news for AIDS educators, Quarles says. "In order for messages around prevention to resonate, people need to believe they have a future that is worth protecting."
Before leaving Grand Gedeh, Quarles delivered a half-day AIDS-awareness training to ten Mercy Corps staff members and eight local trainers, who are pivotal in convincing young people to adopt healthy behaviors. Quarles may not be a star on the soccer pitch, but Michelle Rebosio, who oversees the YES program for Mercy Corps Liberia, says her hopeful message still resonated.
"She has a way of talking to people that lets them know they'll be okay, that HIV can be prevented and, hopefully, treated. She also got out the message that having HIV doesn't make someone bad, but that we're all at risk of getting HIV by the simple fact that we're human."
Quarles knows there's a lot more work to be done, and that the agency must move quickly to take advantage of the nation's newfound optimism. But at the end of her two-week visit, she was feeling upbeat. "I sense a strong desire among Liberians to see the fruits of peace," says Quarles. "People want to make up for lost time. They are making plans for their future. It's a wonderful opportunity to do AIDS work."