MEXICO CITY, Aug. 5 In a new report released today, aninternational panel of AIDS experts calls on global leaders to aggressivelyexpand HIV prevention programs aimed at reducing high-risk behaviors,including unsafe sex and drug use. Citing hundreds of clinical trials andobservational studies, the report concludes that behavior-change programs arehighly effective for preventing HIV, but do not currently reach enough peopleto have a decisive impact on the epidemic.
The report, released by the Global HIV Prevention Working Group, notesthat while many are skeptical about the effectiveness of behavioral HIVprevention programs, these interventions have been central to all nationalefforts to reduce HIV infection rates. Review of national prevention programsthat include evidence-based behavior-change strategies shows that they havebeen associated with an overall 50%-90% decline in HIV infections in keypopulations.
"Behavioral HIV prevention works. Some have been pessimistic that it'spossible to reduce HIV risk behaviors on a large scale, but this concern ismisplaced," said Dr. Helene Gayle, co-chair of the Working Group, andpresident and CEO of CARE USA. "We should not confuse the difficulty inchanging human behavior with the inability to do so."
The report, titled Behavior Change and HIV Prevention: (Re)Considerationsfor the 21st Century, acknowledges that it is challenging to design effectivebehavior-change programs and monitor their impact, and calls for additionalresearch in these areas. At the same time, the report emphasizes that thereis clear evidence that expanding prevention, including behavior-changeprograms, could save millions of lives -- projections commissioned by theWorking Group show that expanding all scientifically proven HIV preventionstrategies could cut global rates of new HIV infections in half by 2015.
"Unanswered questions shouldn't stop us from supporting proven programs,"said Dr. David Serwadda, co-chair of the Working Group, and dean of the Schoolof Public Health at Makerere University in Uganda. "In the 21st century,reducing risky sex and drug use is absolutely essential for slowing HIV,especially since a vaccine or microbicide could take far longer than hoped."
Report Identifies Key Elements of Successful Behavior-Change Programs
The Working Group report points to diverse examples of success in reducingHIV risk behaviors, including national programs in Uganda, Thailand,Australia, and Brazil. While effective behavior-change programs can take manydifferent forms, they share several common elements, including:
-- Combination prevention: Successful HIV behavior-change programsdeliver a combination of scientifically proven risk-reduction strategies --such as one-on-one counseling, small-group programs, and community educationto encourage people to adopt safer sexual behaviors and avoid risky drug use.
-- Access: Successful behavior-change programs achieve sufficientcoverage, intensity, and duration to have a long-term impact.
-- Tailored strategies: The most effective behavior-change strategiesaddress the main drivers of HIV transmission, and are tailored to specificneeds and circumstances of groups at high risk.
-- Community support: Successful behavior-change programs have strongcommunity involvement and support.
"When it comes to reducing HIV risk behaviors, a 'one-size-fits-all'approach doesn't work," said Dr. Salim Abdool Karim, pro-vice chancellor forresearch at the University of KwaZulu-Natal in South Africa, and a member ofthe Working Group. "That said, the successful efforts we reviewed sharestriking similarities -- they deliver a combination of proven strategies,reflect local needs and circumstances, and are widely accessible to those atrisk."
Greater Leadership, Resources Needed to Strengthen Behavior-Change Efforts