Tanzania and the Fleet of Hope

In Tanzania, the first cases of HIV/AIDS were reported in 1983 in the northwest region, south of Uganda. From there HIV spread to the rest of the country; by the end of 2002, estimates of prevalence ranged from 9.6 percent among attendees at antenatal clinics to 11 percent (among blood donors), with variations among regions of the country (MEASURE Evaluation, NACP, and Bureau of Statistics, 2001). The government established a National AIDS Task Force in 1985, and since 1987, Tanzania has mounted a national response through the Tanzania National AIDS Control Programme (NACP).

The NACP’s first Medium-Term Plan for 1987 to 1991 to reduce spread of HIV, included programs to increase blood screening, enhance clinical services for HIV/AIDS patients, implement epidemiologic surveillance and other research, and eventually initiate STI treatment, based on etiologic management (FHI, 1997). Dr. Justin Nguma (2004) of HealthScope Tanzania remembers that during those years, NACP’s main promotional message was “AIDS Kills.” However, the fear-based messages became boring to their audience and did little to change behaviors. There were also posters about how HIV is transmitted—through sex, blood, and mother-to-child transmission (MTCT)—as well as myths and misconceptions about the disease. The protection messages for sexual transmission addressed abstinence, faithfulness and condom use, but neither explained why these behaviors were important nor how to accomplish them. According to Nguma, “The messages then were not put together into ‘ABC.’”

In Tanzania, as elsewhere, the debate between behavior change and condom use arose early. In the late 1980s, Fr. Bernard Joinet, a Catholic priest who taught clinical psychology at the University of Dar-es-Salaam, had an idea about how to communicate a common message about the behaviors that prevent sexual transmission of HIV. He had seen the toll AIDS was taking in Tanzania and had attended contentious meetings, including one in Bukoba city in the highly affected Kagera region in the northwest. During the meeting, members from the church and international NGOs discussed different strategies for HIV/AIDS prevention, including the role of condoms. He had attended a class held at the university at which Dr. Justin Nguma talked to students about HIV/AIDS being like a war and that people should stay inside (not be sexually active) until they knew they would be safe outside (with an uninfected partner or by using a condom).

Inspired by the biblical story of Noah’s Ark, Joinet came up with the idea of representing HIV/AIDS as a flood in which people were drowning and the only way to escape the flood is to board one of three boats: “Abstinence,” “Fidelity,” or “Rubber Lifeboat” (condom), as shown in image 3. Joinet’s intention was to present all three behaviors as acceptable options. The approach sought to encourage people to board whichever boat fit their life situation. When life situations changed, people could move from one boat to another (Joinet and Nkini 1996). In that way, the approach was flexible because getting into one particular boat could be a temporary or permanent situation. The boats operationalized the prevention behaviors in a way that focused on safe sexual behaviors and without moralizing.

Image 3: Tanzania's Fleet of Hope: 1994 (www.kits.nl)

The “Fleet of Hope” did not aim simply to provide information about HIV/AIDS. The prevention messages communicated through the Fleet of Hope were intended “to awaken people’s emotions…to help them believe they can escape the epidemic” (Williams, Milligan & Odemwingie 1997, 45). Additionally, Joinet wanted the Fleet of Hope to be a middle ground on which people could agree as a single, comprehensive approach to HIV prevention. As a Roman Catholic priest, Joinet sought a prevention approach that appealed to his own and other religious groups that emphasized abstinence and fidelity in marriage. However, he also sought a compromise between the messages of abstinence-fidelity and condom promotion.

Adaptations of the Fleet of Hope in Tanzania and Beyond

Over time, the graphic representations of the Fleet used in Tanzania have changed. Early pictures (shown below) show three wooden boats of the same size connected with wooden planks. Later representations of the concept present two wooden boats labeled “Abstinence” and “Fidelity” accompanied by a smaller “Rubber Lifeboat” (Tiendrebeogo and Buykx 2003). Such changes in the presentations may also represent changes in the priorities and emphasis areas of HIV prevention programs. The Fleet of Hope continues to be used in Tanzania, as a review of posters and other print materials by Hardee at the National AIDS Commission in April 2004 revealed (images 4 and 5).

Image 4: Page from the National AIDS Control Program Calendar, 1997. Photograph by Karen Hardee.

Image 5: Vocational school gate painted with the Fleet of Hope, 2004. Tanzania. Courtesy of Peter Riva, HealthScope. Photograph by Ulla Vaeggemose.

In neighboring Uganda, the Fleet of Hope was adopted, but modified to communicate a different message. The modification included only one boat with two messages—“do not have sex” and “stick to your partner.” People falling off the boat were encouraged to use a life jacket, referring to a condom (image 6). A different interpretation of the graphic representation was that the one boat represented A, B, and C—the ways of preventing transmission—and if a person fell off the boat, the chances of death were very high. In fact, many, including Steven Forsythe of the Futures Institute, remember the use of the term “ABC or D(eath)” used in Uganda and other countries in the 1990s (Forsythe, 2004).

Image 6: Uganda, Adaptation of the Fleet of Hope, 1995. Courtesy of Jhuccp.org

The Fleet of Hope has been adapted for use throughout the world, including Burkina Faso, Ghana, Zimbabwe, Nigeria, Kenya, and Haiti. The Fleet of Hope also served as the basis for other HIV prevention programs, including “Stop AIDS. Love Life” in Ghana; the “Bridges of Hope” program in Zimbabwe; and “Fleet of Hope with Future Islands,” which has been used in many countries in Africa. The “Fleet of Hope” theme was a theme in folk art, religious services, and media presentations (Henry 2003). The United Nations Development Program (UNDP) and UNAIDS have also incorporated the Fleet of Hope into program activities (UNDP, 2000).

Other Uses of ABC in Tanzania

Population Services International created a social marketing campaign using ABC messages in the mid-1990s, with posters for abstinence, fidelity/partner reduction and condom use (image 7).

Image 7: PSI's first social marketing poster promoting ABC in Tanzania. Printed in Williams, Milligan and Odemwingie, 1997: 48.

Tanzania has more recently implemented a comprehensive ABC campaign for youth, with funding from a number of donors, including the President’s Emergency Plan for AIDS Relief (PEPFAR). The first slogan used by the “Ishi” (Life) campaign promoted A and C. The campaign has also addressed B, based on the fact that many young people frequently change partners. The Ishi campaign tells young people, “Usione Soo—Don’t be shy!—talk to your partner about waiting, being faithful, or using a condom.” According to Dr. Nguma, “The ABC behaviors are the same being promoted now as before, but now they are being promoted by appealing for actions based on social context and issues facing young people and by providing a rationale for taking action.”