Poor information and a lack of open discussion about sex is fueling an increase in HIV in postwar Sierra Leone, according to Dr Brima Kargbo, acting director of the country's National AIDS Secretariat (NAS).

In response, Kargbo's organisation is launching a massive awareness campaign entitled the "Accelerated HIV/AIDS Prevention Programme".

The capital, Freetown, and villages and towns in the hinterland are filled with anti-HIV posters and billboards: "Let's abstain from unsafe sex, use condoms"; "HIV/AIDS is real, Prevent it."

Military and police posts have also been targeted with messaging: "A force for good uses condoms", some proclaim.

NAS hopes the programme and its slogans will curb what Kargbo describes as the "rapid spread" of HIV in the West African country.

Sierra Leone has a prevalence of 1.6 percent, according to UNAIDS. At the end of 2006, NAS reported 48,000 Sierra Leoneans were living with HIV.

For NAS, outreach to rural areas will be a continued focus, not only with billboards but programmes encouraging traditional leaders and parliamentarians to discuss prevention with their communities.

"In our Sierra Leonean culture, people listen to their traditional leaders like town and clan chiefs and parliamentarians, and because of this behavior we are getting those leaders involved in this exercise," Kargbo said.

Additional voluntary testing and counseling (VCT) centres will be created alongside such efforts.

A culture of silence

However, awareness programmes and VCT centres may not be enough; Kargbo believes people's shyness over openly discussing sex will also have to be tackled.

"Our people are so embedded in traditional ways of life. Here in Sierra Leone, most of the tribes do not allow elders to openly discuss sex education with younger ones nor the younger ones to discuss it among themselves," said Aisata Fereh, a hairdresser in one of Freetown's busiest streets.

Haja Wurie agreed: "It is an abomination to openly discuss sex. I never saw it when I was growing up in the village, and people nowadays stick to it [the practice]. Only partners can talk about that in private."

But Ahmed Marah, a university student, argued that AIDS is a global phenomenon and needs to be discussed more openly.

"If we can not erase that ancient mentality of discussing sex education, then our young generation will be at risk. They will easily contract the virus since they have not been discussing the issue," Marah said

Cultural practices

Kargbo fears some traditional practices can spread the virus, such as facial tattooing - often done with unsterilized razors - which remains common in the east of the country. However, community leaders in the region have denied any link between the custom and HIV/AIDS.

"For hundreds of years we have been using objects to mark our faces, it's a tradition we have lives with," said Moiba Kallon. He belongs to the Mende ethnic group, one of 18 that practice facial marking. "For those years of practicing it, we never knew of AIDS, so why now?"

But some share Kargbo's fear, like Jimmy Smythe, who sells rice in Freetown. "One cannot easily tell who has contracted the virus, and his face is marked with a razor. The same razor, not sterilized, can be used on another person who is negative."