Behaviour and communication change in reducing HIV: is Uganda unique?

Abstract

The clearest example of declines in HIV prevalence and changes in sexual behaviour comes from Uganda. Are there lessons to learn for other countries or is Uganda unique? In this paper, we assess the epidemiological and behavioural data on Uganda comparatively to other African countries and then analyse data from other populations where HIV has declined. In Uganda, HIV prevalence declined from 21% to 9.8% from 1991-1998, there was a reduction in non-regular sexual partners by 65% and greater levels of communication about AIDS and people with AIDS through social networks, unlike the comparison countries. There is evidence of a basic population level response initiated at community level, to avoid risk, reduce risk behaviours and care for people with AIDS. The basic elements-a continuum of communication, behaviour change and care-were integrated at community level. They were also strongly supported by distinctive Ugandan policies from the 1980s. We identify a similar, early behaviour and communication response in other situations where HIV has declined: Thailand, Zambia and the US Gay community. In Thailand, visits to sex workers decreased by 55% and non-regular partners declined from 28% to 15% (1990-1993): as important as the '100% condom use policy'. Similarly, in Zambia and Ethiopia risk behaviour has decreased and analysis of Sexually Transmitted Disease (STD) rates among Gay populations in the USA shows a decline from as early as 1985 in White Gay populations, with later declines in Hispanic and Black Gay populations. These responses preceded and exceeded HIV prevention. However, where they were built on by distinctive HIV policies, HIV prevention has been scaled and led to national level declines in HIV. It is not easy to transfer the lessons of these successes. They require real social and political capital in addition to financial capital. Nevertheless, similar characteristics are present in community responses in Africa, Asia and USA, and even in fragmented signs of HIV declines in other African cities. Only in a few situations has this behaviour and communication process been recognised, mobilised and built on by HIV prevention policy. Where this has occurred, HIV prevention success has been greater than biomedical approaches or methods introduced from outside. It represents a social vaccine for HIV from Africa, and is available now.

Factors associated with delayed diagnosis of HIV infection in Mukono district, Uganda

“…The respondents often mentioned quick progress of the disease and dying faster as effect of one knowing his/her sero status which may be an expressed form of fear of positive results. It has been shown that fear of positive HIV results may be a barrier to HIV testing (17)(18)(19)(20)(21). Similarly as expected late testing was favoured by having an illness in the last two months suggesting that HIV/AIDS related or similar symptoms may actually influence the decision to undertake a test (16)(17)(18)(19).…”

Waardegedrewe gemeenskaps-kommunikasie – die sosiale entstof teen MIV en VIGS?

“…Netwerke het teoreties 'n beduidende invloed op gedragsverandering (Low-Beer & Stoneburner, 2003). Tradisioneel was die gesondheidsdeskundige of die gemeenskapsleier die enkele fasiliteerder of bron van inligting.…”

“…In Uganda het die voorkoms van VIGS vanaf 20% in 1992 tot 9,8% in 1998 gedaal, met 'n verdere afname tot 6,1% in 2001 (Butcher, 2003:4;Low-Beer & Stoneburner, 2003). Hierdie afname is aan verskeie faktore toegeskryf, maar veral aan die volgende: die toename van volgehoue interpersoonlike kommunikasie op alle gemeenskapsvlakke, primêre gedragsverandering deur onthouding en monogame verhoudings, asook die sorg vir VIGS-lyers.…”

Male Circumcision is Not the HIV ‘Vaccine’ We Have Been Waiting For!

“…Uganda, Senegal and Thailand have successfully lowered their HIV-infection rates without resorting to surgery. For example, HIV prevalence declined in Uganda by 47% following increased safe-sex education and condom promotion [7]. This 'social vaccine' is available and effective now and does not entail the complications of surgery.…”

“…Campaigns to promote safe-sex behaviors have been shown to accomplish a high rate of infection reduction [7], without the surgical risks and complications of circumcision, and at a much lower cost. For the health community to rush to recommend a program based on incomplete evidence is both premature and ill-advised.…”