Behavioural strategies to reduce HIV transmission: how to make them work better

Abstract

This paper makes five key points. First is that the aggregate effect of radical and sustained behavioural changes in a sufficient number of individuals potentially at risk is needed for successful reductions in HIV transmission. Second, combination prevention is essential since HIV prevention is neither simple nor simplistic. Reductions in HIV transmission need widespread and sustained efforts, and a mix of communication channels to disseminate messages to motivate people to engage in a range of options to reduce risk. Third, prevention programmes can do better. The effect of behavioural strategies could be increased by aiming for many goals (eg, delay in onset of first intercourse, reduction in number of sexual partners, increases in condom use, etc) that are achieved by use of multilevel approaches (eg, couples, families, social and sexual networks, institutions, and entire communities) with populations both uninfected and infected with HIV. Fourth, prevention science can do better. Interventions derived from behavioural science have a role in overall HIV-prevention efforts, but they are insufficient when used by themselves to produce substantial and lasting reductions in HIV transmission between individuals or in entire communities. Fifth, we need to get the simple things right. The fundamentals of HIV prevention need to be agreed upon, funded, implemented, measured, and achieved. That, presently, is not the case.

Figure 1. Highly active HIV prevention

This term was coined by Prof K Holmes, University of Washington School of Medicine, Seattle, WA, USA. STI=sexually transmitted infections.

Figure 2. Adherence to HIV prevention technologies

Adapted from reference 89 with permission from author and publisher.

Figure 3. Percentage of sex workers, injecting drug users, and men having sex with men who are reached by HIV prevention programmes

*Percentage of sex workers and men having sex with men who reported knowing where they can receive an HIV test and that they were given condoms. †Percentage of injecting drug users who reported knowing where they could receive an HIV test and be provided with condoms and sterile injecting needles and syringes. Reproduced from reference 22 with permission from author and publisher.

Figure 4. Percentage of young people aged 15-24 years who have comprehensive knowledge of HIV

Adapted from references 22 and with permission from author and publisher.

Figure 5. Comprehensive knowledge of HIV among young people, by type of question

Reproduced from reference 22 with permission from author and publisher.

Figure 6. Percentage of young people who have first sexual intercourse before 15 years of age, by sex

Reproduced from reference 22 with permission from author and publisher.