Soccer fans around the world may be wringing their hands over the quarterfinals of the World Cup, but some doctors are agonizing over a more serious stake in the tournament -- they hope to slow HIV transmissions during World Cup celebrations.
Any major sports event carries a risk of upping sexually transmitted diseases among celebrating fans. Doctors say alcohol, parties and the anonymity of traveling abroad are the perfect storm for unsafe sex.
So when South Africa, which has one of the highest HIV/AIDS rates on the planet, was named as the 2010 host for the World Cup, public health advocates saw a window of opportunity and a window for disaster.
"It was an ethical issue because we have such high HIV rates, many visitors may not know the risk they are at in having sex in South Africa," said Dr. Sue Goldstein, senior executive of South Africa Programs of Soul City: Institute for Health and Development Communication in Johannesburg.
"In South Africa, many people do not know their HIV status, so you can ask someone if they're HIV positive and they'll say 'no,' because they don't know," said Goldstein.
UNAIDS, the United Nations program on HIV/AIDS, estimates just over 18 percent of the adult South African population is HIV positive. Only three other countries have higher HIV infection rates.
Dr. Charles van der Horst, a professor of medicine at the University of North Carolina School of Medicine in Durham, said prevention efforts have worked before in Sub-Saharan Africa.
"In Malawi it reached 23 percent of the population affected," said van der Horst, who works in HIV/AIDS care in Malawi and South Africa. By 2007, the HIV rate in Malawi dropped to 11.9 percent according to the United Nations AIDS program.
But in South Africa, van der Horst said young people may be at a particularly high risk for contracting HIV during World Cup celebrations.
"HIV will spread whenever you have a large gathering of people, including tourists, making use of prostitutes, getting drunk, and drug use -- including large numbers of people having sexual activity," said van der Horst.
Young Fans May Be at Risk for HIV
"The least-prepared are going to be the young -- all young people anywhere on the planet, they don't see themselves as vulnerable," he said.
Advocacy groups and the South Africa National AIDS Council (SANAC) were betting that young people were going to be interested in World Cup festivities, and thought it was a golden opportunity to spread the word about safe sex and pass out condoms.
Yet as the World Cup approached, several organizations cried foul to the press when the governing body of the World Cup, Federation Internationale de Football Association (FIFA), either ignored or rebuffed attempts to distribute condoms and educational materials at stadiums and FIFA-sponsored events.
Negotiations to Combine Condoms and Soccer
In early June, SANAC deputy chairperson Mark Heywood told a news service of the Nations Integrated Regional Information Networks that his group's plans for HIV education would fall short without help from FIFA.
"There were big plans, and they haven't come off. FIFA has not engaged SANAC on how the event can be used to assist with messaging and mobilizing around HIV, and consequently we're faced with a dreadful missed opportunity," Heywood told PlusNews in a June 4 article.
At first, Federico Addiechi, head of FIFA's Corporate Social Responsibility department, defended the right of FIFA to steer clear of the issue during World Cup events.
"We receive hundreds of requests for different causes, which are all legitimate, and we have the difficult task of having to say no," Addiechi told PlusNews. "Within FIFA I'm pushing for as much space as possible [for social causes], but there are limitations; it's impossible to speak about HIV, and about human rights, and about human trafficking, and violence and gender equity ... because we are the World Cup, and we should be speaking about football [soccer]."
But eventually FIFA allowed free distribution of condoms at fan events, and broadcast HIV-prevention messages on giant screens, according to a statement FIFA e-mailed to ABCNews.com.
"It has been cleared up. After negotiations FIFA did allow condoms and HIV/AIDs information to be distributed at games, stadiums and fan parks and hotels," said Goldstein.
Goldstein said education has been especially important in South Africa, where expectations of who is at risk for HIV/AIDS are different than in most of the world.
"In countries where there's a smaller epidemic, the very high-risk group is prostitutes, men who have sex with men and intravenous drug users," said Goldstein.
"In South Africa we have a hyper-epidemic where the highest-risk group is the general population. People from countries where there's a smaller epidemic might think that if they avoid having sex with prostitutes they're safe, but that's not true," she said.