Prof. teaches African nursing educators HIV prevention Finds cultural barriers impeding actual progress in the fight of the disease BY TOM CAIAZZA Staff Writer EDISON - Dula Pacquiao had one week to change the world. The associate professor and director of the Stanley Bergen Jr. Center for Multicultural Education, Research and Practice at the University of Medicine and Dentistry of New Jersey (UMDNJ)-School of Nursing spent one week in Botswana teaching nurses safe practices to stop the spread of HIV/AIDS in the small, impoverished African nation. Pacquiao, 60, of Edison conducted a five-day workshop on HIV treatment, prevention and care that focused on Western medical methods and nursing theory. Botswana is among the leaders in providing antiviral medication to those infected with the disease, though Pacquiao said there are serious cultural barriers inhibiting the success of the medications. She went as part of an international group of experts sponsored by Francois-Xavier Bagnoud, a charity that raises funds and provides relief to AIDS-orphans throughout the world. "There is a great difficulty in accepting the use of condoms," Pacquiao said. Botswana is a male-centric culture where the value of a woman is significantly less than a man. Pacquiao said that in this situation, there is little opportunity for an equal conversation about safe sex. "Males are more dominant than women and women will have difficulty negotiating safe sex if the male does not agree," Pacquiao said. Pacquiao said the use of condoms is thwarted by the desire for sexual contact to produce a result - a child. The Botswanan people value fertility and virility, making safe sex contradictory to the cultural desire to procreate and experience skin-to-skin contact as part of their sexuality. "It's no wonder they have one of the highest prevalences of AIDS," Pacquiao said. According to AVERT, an international AIDS charity, Botswana has the second highest percentage of infected persons in the world. Nearly 25 percent of their adult population is infected with HIV, and 270,000 people of all ages out of a population of just under 2 million live with the disease. The life expectancy in Botswana plummeted by nearly 28 years during the period of 1995 to 2005 from 65 to just under 40. It is a country ravaged. Pacquiao said that the cultural stigma surrounding AIDS is keeping many people infected with the disease from seeking treatment. The fear of being identified as having HIV is enough to stop safe-sex practices from emerging, she said. "There is so much of a stigma to HIV that people are hesitant to get tested and get treatment because they fear they may be identified," she said. "It paralyzes people." Pacquiao said that the fear is so great that mothers will often refuse to give newborns a diet that is exclusively formula. "If you have HIV as a mother," Pacquiao said, "and you breast-feed, there are studies that say it will transmit the disease to the baby. Many will not bottle-feed for fear of being identified with the disease." Pacquiao traveled as part of a panel of health-care experts. The group spent only five days working with the nurses. She said she would like to spend another week. "I would love to; this is something that I feel that I can contribute, and it is so much needed," Pacquiao said. "I think in time this group will probably really be moving forward, and it's only a matter of presenting something in a way that is compatible to how they are, so they see it as something that is doable." The cultural barriers, Pacquiao said, are what are standing in the way of true progress in the fight against HIV/AIDS. But she is hopeful that a country affected by the rampant pace of the disease can change. "Cultures can change," Pacquiao said. "It takes time, but they change."