We recently had Jim Shelton in to talk with us about some of the new work we are undertaking in HIV prevention. Jim is the author of a recent paper in The Lancet (a free subscription) that takes aim at some of the mythologies and misconceptions about the nature of generalized HIV epidemics in light of recent research findings. For social marketers, here are a few of the more salient ones that might influence how you think about segmentation and priority audiences.
HIV spreads like wildfire — Typically it does not. HIV is very infectious in the first weeks when virus levels are high, but not in the subsequent many-year quiescent phase.
Sex work is the problem — Formal sex work is uncommon in these generalised epidemics.
Men are the problem — The importance of women in generalised epidemics is evidenced by the high proportion (sometimes the majority) of discordant couples in which the woman, not the man, is HIV positive.
Adolescents are the problem — Although adolescent women are affected through sex with older men, HIV incidence increases in women in their 20s and later in life. Men are infected at even older ages. Thus interventions in young people, including abstinence, although important, have limited usefulness.
And for the nay-sayers who believe that behavior change efforts are fruitless he adds another point.
Actually, facing the prospect of deadly illness, many people will change. Homosexual men in the USA radically changed behaviour in the 1980s. And the reductions in HIV incidence in Kenya and eastern Zimbabwe were accompanied by large drops in multiple partners, probably largely as a spontaneous reaction to fear.
As for his truth -
...our priority must be on the key driver of generalised epidemics — concurrent partnerships.
Separating facts from myths, ideologies and values can be difficult. But getting the science right must be a first step to developing effective social marketing interventions. Educating policy-makers is another.
And if this list intrigues you, read his Confessions of a condom lover, also in The Lancet.