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While virologist Phyllis Kanki fights AIDS in Nigeria with Ivy League research labs and $25 million at her disposal, a 27-year-old graduate student in history at Stanford hopes to start a similar prevention initiative in Togo -- with notably less backing.
When he is not studying African history, Benjamin Lawrance is a senior counselor for Stanford's anonymous HIV testing and peer counseling center. Like Kanki, he believes students are especially vital to a population's well-being, yet vulnerable when it comes to AIDS. During a recent stay in western Africa, Lawrance noticed a need for HIV education among the local students. So he set out to create a version of the Stanford program -- selected by the U.S. Centers for Disease Control as a model school project for the past five years -- at Togo's University of Benin.
Togo is a tiny sliver of a nation -- not more than 100 miles wide on the western coast of Africa -- and in the shadow of its giant neighbor, Nigeria. Togo doesn't get a lot of attention, and not many people in the United States know much about it. Lawrance, however, knows plenty. He spent a year living there, examining the country's culture and history. The title of his doctoral thesis is "Nationalism and Construction of Ewe Ethnic Identity Under League of Nation Mandates of Togoland 1919-1945." But even as he studied the nation's past, Lawrance couldn't ignore the present-day trials of a country under assault by AIDS. What if, Lawrance wondered, the next generation of Stanford historians had to write their papers on how Togo met its demise?
Moved by such thoughts, he began to network with anyone he could from the local Rotary Club, the health ministry, and the university, with the goal of bringing Stanford's HIV program to the students of Togo. "I made a case for a group of people whose HIV concerns must be met in order to maintain the functioning of the nation-state, and I saw myself as a bridge between a successful program at Stanford and the battle zone in Togo," says the native of England, admitting he is far from the voice of authority on the issue. "I just saw this as something I could do, in a place where nothing else was being done."
There are obstacles, however. For example, the program's success depends on students counseling fellow students, but it won't be as easy to find volunteers in Togo. At Stanford, Lawrance says, the drive to build an impressive résumé provides incentive to do community service, but the pursuit of the perfect résumé is not as important in west Africa. "Extracurricular activities are only something students in Togo are willing to get involved with when their other general living needs are met," Lawrance says. "And HIV is not a big issue. When you are living hand to mouth, you don't tend to sit down and worry about health issues."
Lawrance says many students are indifferent to HIV and distrust HIV tests. The story of one of Lawrance's Togolese friends is a prime example. The young man never had access to informed HIV counseling or anonymous testing, and regularly practiced unsafe sex. He didn't trust any test that required him to give his name, so he refused to learn his HIV status. When he became sick, exhibiting some AIDS-like symptoms, the student assumed he had contracted the disease and continued to engage in risky behavior, thinking it did not matter. In fact, he had been ill with typhoid fever, not AIDS. Lawrance helped his friend get properly tested and diagnosed, and then counseled him on how to remain healthy. The young man was more inclined to listen to a peer, and more likely to get tested if his anonymity was guaranteed.
Before returning to Stanford earlier this year, Lawrance laid some groundwork for the student HIV program in Togo. Though he found it a chaotic adventure to get anything done through the government or the university administration of a developing country, Lawrance made some key contacts, wrote a position paper, and set up a Web site (www.stanford.edu/~lawrance/ CCD/jeunes.html). Now, as he prepares to graduate from Stanford, he is trying to muster the support and funding to put his Togo idea into operation.
Kanki has read his plan and is impressed. "Mr. Lawrance is very well informed," she says. "His proposal is reasonable and generally rational. The success of the Stanford counseling effort is a nice focal point."
Carole Pertofsky, founder and director of the Stanford HIV program, has confidence in Lawrance's ability to make the Togo effort work. "Ben is not only a gem of a counselor; his creativity and dedication to customizing the program to the needs of Togo is commendable," Pertofsky says. "I think his natural instincts inform him when to push on and when to pull back, how to read the complexities and subtleties of a situation, and how to read the political wind -- all crucial elements in starting such a program."