As Switzerland Rises to Meet New Challenges in HIV Prevention, A&U's Dann Dulin Discovers the country's Many Faces of AIDS Activism
Swiss Army knives, Swiss cheese, Swiss chocolate, Swiss bank accounts–the Swiss are so integrated into our mass culture, they're almost as American as apple pie. No wonder Switzerland is known as "The Little Big Country." During my recent visit to Switzerland, I came to understand just how creative and skilled a people had to be in order to produce goods of such refinement and quality. Though nestled in the majestic Alps high atop the European continent, this ancient and properous nation has not escaped the scourge of HIV. Now, they must confront their domestic AIDS crisis, using their own unique skills and resources, with the stark awareness that more than just the blessings of material wealth are needed to combat the pandemic.
Since 1983, Switzerland, with a population of 7.2 million, has reported close to 8,000 AIDS cases, and 26,000 HIV-positive infections. "We started to think about HIV before we even had the problem," asserts Dr. Bertino Somaini, from his office near the center of Bern, a medieval city founded in 1119 A. D. and the nation's capital. Dr. Somaini was on the frontlines from the very beginning of the crisis as head of epidemiology at the Swiss Federal Office of Public Health (SFOPH) from 1981—1993. He is no longer involved directly with AIDS research, currently devoting his time and energy to general public health promotion and prevention, as director of Health Promotion Switzerland.
In 1986, the STOP AIDS campaign was initiated by SFOPH and the Swiss AIDS Federation (SAF), an alliance of several gay groups, and continues to this day. Dr. Somaini points out that the campaign was a collaborative effort of many groups, including public relation firms, gay organizations, and governmental bodies. "We knew from the beginnig that we had to be frank, clear, and that people needed to understand what was going on," says Dr. Somaini. "This is where we differed from france, where only limited information was made available tot he public." Initially, the campaign was quite shocking, with the "O" in the STOP AIDS logo represented by a condom. Today the ads are astill controversial, though seventy percent of the population currently approves of the campaign and condom use has increased.
The STOP AIDS campaign also has an ingenious plan to confront AIDS in the drug community. "Switzerland differs in their prevention campaigns from many other countries," says Michael Hausermann, a gay activist and former SAF manager, who along withe Jen Wang, a University of Zurich epidemiologist, founded the Geneva Gay Men's Health Project. "For example, we distribute needles as well as heroin [to users], and these programs have been very efficient. It shows that if these people are viewed as partners in healing, rather than as bad or immoral people, they can change their destructive behavior. Distributing heroin became a topic of worldwide discussion." Wang comments: "Drug users often have to commit illegal acts to get their fix. They are socially marginalized. Drug users come to the centers, they get emotional counseling, job counseling, housing assistance, and medical treatment. The drug user is treated as a whole person. We engage them in social medical care." This unique approach evolved in the mid-nineties following the syringe exchange program that had been established in the late eighties. Americans may recall the media exposure and controversy surrounding the distribution of needles in Zurich's Platzspitz, better known to us as "Needle Park," which operated until 1997.
"The IV drug user has become a vanishing target group due to Switzerland's very liberal drug policy," stresses Jan Suter, who handles international affairs for SAF in Zurich, known as the heart of Switzerland. "Our other target groups are youth, the migrant community, male sex workers, and their customers." François Baur, president of Pink Cross, agrees with Suter that male prostitution is a disturbing issue. (Pink Cross is a gay human rights group which works to bring AIDS prevention back to the forefront of public awareness, continually lobbying Parliament about the need for public dissemination of AIDS information and it acts to secure funding for AIDS causes).
"There is a large population of male prostitutes in Zurich that come from Asia and Brazil. Some are illegal and cannot get support by the state but they need support and counseling," explains Baur. "Right-wing parties wanted to cut the funding away for projects of this nature but we rallied the other legislators and secured the votes against such funding cuts."
Hopefully the Swiss can also tackle an increasing component of the larger AIDS problem—immigration. "There is an increase in prevalence which indicates [immigrants] may already have been HIV-positive before moving to Switzerland. Many immigrants are ignorant about the disease," he says in a sturdy tone. "We have a problem with xenophobia so we have to be very careful."
"Indeed, discrimination must continually be addressed because we are human beings who live in a society that discriminates," Jen Wang says with conviction. "Unfortunately, it's only natural." Pink Cross works to fight the stigma associated with AIDS. "People still don't want to get involved with a person with HIV. I'm very reluctant to have sexual intercourse with them too—of course," François Baur admits. He adds, "That's the point. Nobody wants to be open about it. We want to get it back into some normal level. That may sound a bit dramatic but..." Jen Wang sums up: "Discrimination must continually be addressed especially among the immigrant community."
The influx of immigrants from Sub-Saharan Africa has, indeed, contributed to the increase in Switzerland's rate of HIV infection, according to Michael Hausermann. "This is a hot political issue, not only here but in the rest of Europe. There is no epidemic among the straight Swiss man or woman. However, HIV is hitting other groups, like Sub-Saharan Africans." Helena Urfer, coordinator of the STOP AIDS Campaign, concurs with Wang and Hausermann that the number of AIDS cases in the immigrant community is high, not increasing, but continually high. African migrants have already begun a project of their own which has been mandated by the SFOPH in collaboratoin with two NGOs. "The problem," admits Urfer, "is finding new techniques, new ways to get the prevention campaign out to the masses before the campaign goes sour,"
This is a definite challenge especially as it relates to teens, another important target group. SFOPH is very active on the Internet, and offers a game called Catch the Sperm, which has been downloaded twenty million times worldwide. "Integrating HIV education into sexual education in schools is the key," explains Christine Kopp, medical anthropologist and manager of the National HIV/AIDS Program. Swiss education is localized at the canton level, and there are different approaches to prevention in the various schools. Teachers provide some information, and special counselors who visit the schools discuss pregnancy, birth control, and HIV. "We have found that some cantons do it better than others. We try to find the best models and put them to work," specifies Kopp. "The goal is continuous education."
"Right now," says François Baur, "we are very concerned about the under twenty-five population because they haven't witnessed all the initial AIDS deaths. There has been more of an increase among heterosexuals, though the numbers in the gay community are still greater. And in the past two years, there has been an increase in HIV infection among younger people, not heavy, but a steady increase nonetheless."
Is the campaign reaching the Swiss youth? Are they heeding the call? My assistant/photographer and I hit the road to find out. After Bern and Zurich, we drive southward to the breathtaking village of Grindelwald, which lies at the edge of a glacier in the mighty snow-capped Alps. As guests of the Hotel Eiger, we received full use of the local recreational center with its indoor pool. There we meet a number of teens and college students who confirm that they are well-aware of the AIDS situation, and practice safe sex as a result of their country's public education campaigns.
During our discussions, I am struck by a thought: Back home I would pronounce anything with the word "Swiss" attached to it as one word—Swisscheese, Swisswatches—not really acknowledging that they are connected to a country and a people. Never again will I make that mistake! Behind the AIDS programs, the campaigns, and the political controversy, there are real people at risk, as well as resourceful and caring people who have developed a crafted, thoughtful, and compassionate approach to their nation's health crisis. For me, the Swiss now have a face.