While the world awaits findings from new AIDS prevention trials, millions of people are becoming infected because governments are overlooking studies showing that behavior modification works Larry Altman reports from the 17th International AIDS Conference in Mexico City (see the widget in the right hand column for up-to-date webcasts and news items from the conference, courtesy of The Kaiser Family Foundation).
The experts said characteristics of the global epidemic varied greatly among and within countries, most of which were not focusing prevention resources where their epidemics were concentrated. Combining these measures and delivering them on a wider scale is crucial to reversing the global H.I.V. epidemic...
The Global HIV Prevention Working Group also released a new report Behavior Change and HIV Prevention: (Re) Considerations for the 21st Century that summarizes the research on behavioral approaches to HIV prevention:
According to the available evidence from these and other studies, effective strategies pursue a combination of behavior change approaches that are delivered with sufficient coverage, intensity, and duration, and that are tailored to address the main drivers of HIV transmission in national epidemics. Effective HIV prevention addresses the specific needs and circumstances of the target population and aims to affect multiple determinants of human behavior, including individual knowledge and motivations, interpersonal relationships, and societal norms. Community engagement and strong political support have been key ingredients of successful national efforts to change behavior to prevent HIV infection.
Among the challenges in moving the prevention effort forward are noted in the report as:
Understand how to move from efficacy in controlled studies to effectiveness in real-life
Whether what is learned about prevention in one context can be generalized to other settings, populations
How to sustain behavioral changes over the long-term
Shift from individually-oriented cognitive behavior change approaches to ones that incorporate a focus on changing social norms and institutions
- Move away from one dimensional evaluations that examine discrete components of behavior prevention programs and instead look at the effectiveness of comprehensive approaches as they are most often applied in real world situations
More about how to scale up behavior change programs to prevent HIV transmission was discussed in an earlier Working Group report and reviewed here. One of the main points I made then was the problem that not enough people responsible for designing and implementing large-scale HIV prevention programs have the appropriate behavior change models (population-focused rather than on individuals) and the social marketing skills to create and manage them.
Note: The Lancet has also released eight reports on HIV prevention that are available online, although in their formidable estimation, only people who subscribe to the journal can have free access to potentially life-saving information - otherwise fork over $40 for a 24 hour on-line trial. I wonder who makes these judgments - and why?