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

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The Lancet 2008; 372:669-684
DOI:10.1016/S0140-6736(08)60886-7
Series, HIV Prevention




Summary

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.

Key messages: Behavioural strategies

•HIV prevention is neither simple nor simplistic. We must achieve radical behavioural changes—both between individuals and across large groups of at-risk people—to reduce incidence. Once achieved, it is essential that such changes are sustained

•Although cognitive-behavioural, persuasive communications, peer education, and diffusion of innovation approaches to change are beneficial within a combination prevention framework, behavioural science can and must do better. Novel theoretical and programmatic approaches are needed to inform new approaches to motivate behavioural change

•Goals for behavioural strategy involve knowledge, stigma reduction, access to services, delay of onset of first intercourse, decrease in number of partners, increases in condom sales or use, and decreases in sharing of contaminated injection equipment. A multilevel approach that encompasses behavioural strategies must be taken—behavioural HIV prevention needs to be integrated with biomedical and structural approaches, and treatment for HIV infection

•The fundamentals of HIV prevention need to be agreed upon, funded, implemented, measured, and achieved in a comprehensive and sustained manner. Access to HIV prevention information, messages, skills, and technologies is essential and a fundamental human right

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