Recent sexually transmitted disease prevention efforts and their implications for AIDS health education

Abstract

In the absence of a cure or vaccine for acquired immune deficiency syndrome (AIDS) educational and social marketing efforts to reduce the transmission of Human T-lymphotropic type III/lymphadenopathy-associated virus (HTLV-III/LAV) are currently our best hope for controlling the disease. Since 1983, the Centers for Disease Control (CDC) has funded a series of research studies to determine whether education efforts can successfully motivate the adoption of key behaviors relevant to the control of a variety of sexually transmitted diseases (STDs). Analysis of the first two studies which are now completed, and preliminary data from a third study, have documented dramatic changes in behavior, knowledge, and attitudes among clients in inner-city public health clinics. The authors describe the principles and underlying assumptions that have guided the design of their STD initiatives, drawing special attention to the implications for AIDS health education efforts.

PIP: The results of a series of 3 research studies to determine whether education efforts can successfully motivate the adoption of key behaviors relevant to the control of a variety of sexually transmitted diseases (STDs) are reported, and some of the similarities and differences are examined between prevention efforts such as those reported, which are aimed at the more traditional STDs, and possible acquired immune deficiency syndrome (AIDS) risk-reduction strategies. With the important exceptions of condom promotion and sex partner notification/referral, the behavioral objectives focused the the 3 studies are unrelated to objectives one would target in an AIDS risk-reduction program. The fact that AIDS is both incurable and fatal distinguishes it from the other STDs. The serious attention directed to AIDS which has resulted is in marked contrast to the often cavalier attitude that many segments of the public take toward gonorrhea, syphillis, and other STDs for which there are cures. Another difference between AIDS risk-reduction and other STD prevention efforts is their location, i.e., most STD prevention efforts have occurred in clinics. For AIDS prevention messageses, educators must reach high-risk groups in the general public who have not been exposed yet or who have been exposed but are asymptomatic. Yet, despite the problems, with creativity and the thoughtful use of multiple channels of communications, AIDS prevention messages will be heard. Recent social marketing campaigns illustrate the range of creativity that can be brought to a community effort. It is particularly well suited for promoting condoms, whose use is critical to reducing HTLV-III/LAV transmission among both homsexuals and heterosexuals. Drama-based methods are especially relevant to AIDS risk-reduction efforts. They offer an excellent means of modeling the communication and interpersonal skills that are fundamental to the behavior changes sought. Drama-based videotapes, for example, would be especially useful for seropositive men and women who face exceptional stress as a consequence of learning their diagnosis. Clinic-based videotapes would be good resources for counselors of seropositive men who face the prospect of telling their diagnosis to wives and women friends who may never have suspected they would be at risk. Drama-based videotapes are not the only ways to create identification or motivate behavior change. Peer education, individual counseling, and social marketing campaign that use a carefully planned mix of media and establish strong campaign themes are other potentially effective approaches. Those social marketing campaigns that have been successful have focused on the consumer, i.e., they were based on an understanding of the target audience's needs, wants, and desires rather than on an institutional decision about what the target audience should want.