The rooster's cry pierced the darkness before 5 a.m., leading a chorus of birds to accompany the rain drumming the iron roof. In the area of Obuasi, which is rich in natural resources and fertile land, miners and farmers go to work at first light.

CARE's Mavis Frimpong leads a community meeting on AIDS. © 2000 Tim Zielenbach/Contact Press Images

Today, however, some 200 residents of the Old Edubease (eh-doo-be-oss) village gathered in the center of town, under the trees by the elementary school. Keeping with Ashanti tradition, the chief sat beneath a royal umbrella, flanked by his spokesman and the queen mother, on a traditional wood-carved stool. Using customs more than three centuries old, the community discussed the most modern of plagues: AIDS.

Frimpong makes some new friends at a hospital near Old Edubease. © 2000 Tim Zielenbach/Contact Press Images

Assisted by CARE, the village meets periodically to talk about AIDS and sexually transmitted diseases and how to prevent their transmission. One at a time, people stand before their friends, neighbors, parents and children, sharing ideas and concerns through a bullhorn.

One man questioned why people with HIV were allowed to live among the villagers. Shouldn't they be quarantined, he asked, to protect others? Another said people who tested positive for the virus should be given support. A CARE counselor said the real threat isn't from people who test positive, but from those who don't know they have the virus and are spreading it.

Though the rain got heavier, the crowd stayed, attracting market women and students in school uniforms. A traveling seamstress listened attentively, a plastic bag covering the sewing machine she carried on her head.

With a clear and simple message, CARE works to educate the public about AIDS. © 2000 Tim Zielenbach/Contact Press Images

With an adult AIDS infection rate of approximately 4 percent, Ghana's rate is half the average of most sub-Saharan countries. However, the Ashanti region, home to the 854 residents of Old Edubease, has the country's second-highest rate of HIV prevalence among people aged 15 to 49.

One woman in her 50s noted that premarital sex is more common now than when she was young. Another blamed the negative influence of television. The queen mother said large families create economic hardship, with parents unable to take care of their children.

The comment prompted Emelia Kwartong, 20, to speak up. Parents too often don't give children the financial support they need, she said, leaving them to find money for food and school fees however they can. When a man offers a young girl money in exchange for sex, she asked "What do you expect us to do?" Kwartong has a 4-year-old son.

Just 1,098 people in the region of 225,000 are known to be HIV-positive, but estimates put the infection rate much higher. Most people are not tested. For many, the fee of 25,000 cedi (approximately $4) is prohibitively expensive.

CARE helps communities educate and care for the next generation. © 2000 Tim Zielenbach/Contact Press Images

Several of the speakers and Chief Nana Amotenpong II said poverty creates conditions that lead people to risk unprotected sex. But there are additional cultural factors, according to CARE Project Manager Joyce Sepenoo. Modern contraception use is low. Some believe contraceptives have dangerous, even deadly, side effects. Others refrain from using contraception for religious reasons.

CARE's Ashanti Region Community Health Project addresses reproductive health issues, including HIV/AIDS prevention and family planning. Community advisors provide services and information through health clinics, the region's hospital, traditional healers, maternity homes and community groups, such as churches, youth groups and professional associations.

Sepenoo estimates the 18-month-old project has reached about 88,000 people. Her team, she said, makes a point of approaching communities in a collaborative manner.

CARE supports programs to improve maternal and child health. © 2000 Tim Zielenbach/Contact Press Images

"We tell them we are not doing this because we think they have AIDS. The disease is a global concern," says Sepenoo, who has a nursing degree and a master's in business administration. "Gradually, we get them to understand. People are using condoms more. People are beginning to engage in safer sex. That's encouraging."

Chief Nana Amotenpong II, wearing the kente cloth and gold jewelry of his region, agrees that CARE's work has made a difference.

"Gradually, the message is getting across," he said. "The elders are reading about HIV/AIDS and helping community members take measures to prevent the spread."