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Posted by plosmedicine on 30 Mar 2009 at 23:38 GMT

Author: Edwin Mapara
Position: Postgraduate Medical Student
Institution: None
Additional Authors: None
Submitted Date: January 04, 2005
Published Date: January 5, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Dear Editor,

after having used coloured pictures/photos to teach, inform and share on all aspects of HIV/AIDS while in Africa and London for the past 20 years, I feel we as health care workers, Public Health teams, health promotion officers, educators and programme managers have contributed to the high HIV/AIDS statistics world wide.We called 'reality' pictures 'shock tactics that do not work'.
Experience has shown me that community people learn better by seeing things or issues.It is not very easy to descibe specific types of rashes to lay people. Show them pictures of the rashes and eureka!They will tell you what that rash is, how it comes about and the traditionaltreatment. Biomedicine has been a detriment in addressing the HIV/AIDS epidemic.It has ignored the social-cultural aspects of HIV/AIDS.
Cultural and traditional beliefs which are in thousands in Africa play a major role in HIV/AIDS management.

Herpes zoster/varicella zoster or shingles rash is believed to be due to an insect or spider having crawled over the person; others believe it to be witchcraft or an allergic reaction! Kaposis sarcoma is 'definitely witchcraft!'
I made an impact in saving a patient's feet, that were supposed to have been amputated in 1992. The wife had seen our slides and had remembered me saying "KS is treatable, it is not witchcraft!"Today the patient walks around in shoe size 8 and has his normal legs.
The traditional doctors became my friends after I had 'treated' the patient. That was my channel for bringing the traditional doctors on board.They taught me a lot of sexual anthropology that has to be addressed.
On genital ulcers the stories are numerous. We as health care workers take a lot for granted. Let pictures talk in your workshops/seminars and lectures, you will be surprised at what you will learn from the lay picturate people.

Pictures do not need translation or interpretation.They are real.

I become distressed when I hear people talk of "...those are shock tactics, they do not work!"

In Africa the lay community are asking why we have delayed in picturing AIDS which is still invisible to many.

We have literature for the literate, why not pictures for the picturate? Have we denied the picturate community?

Competing interests declared: I have no competing interests.