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

Abstract

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.

The Influence of HIV-AIDS Public Enlightenment Campaigns on Adolescents Sexual Behavior in Nigeria

“…This result is also in line with Coates, Richter, and Caceres (2008) who confirmed that behavior modification is best achieved by small peer group sessions and community based approaches rather than large scale campaigns, which produce marginal changes that are difficult to sustain. Zeelen, Wijbenga, Vintges, and Jong (2010) reported adoption of old traditions of storytelling and youth literature as a new methods of AIDS education among South African youths based on findings that mass education focused approaches are not inclusive enough to break with cultural stereotypes.…”

Resilience Factors as a Buffer against the Effects of Syndemic Conditions on HIV Risk and Infection among Tanzanian MSM

“…For instance, Coates et al suggested that a network-based intervention may be an innovative approach for use among groups of stigmatized and vulnerable people, like MSM, who are systematically alienated from health services [7]. This may involve gaining access to the "secret" sexual network by identifying key individuals and training them for the purpose of disseminating HIV-protective strategies.…”

“…Empirical evidence underpins the assertion of Coates et al that delaying the age at which the person had his first sexual intercourse would be effective in reducing HIV transmission [7]. In accordance with that evidence, the participants' answers were first averaged, and then each man's answer was dichotomized as below or above that average age; an above-average age at sexual debut was treated as indicating a protective factor.…”

“…This is because by age 15, adolescents are said to be cognitively capable of making good health-related decisions on the basis of their assessment of their own life situations [28]. On the other hand, although Coates et al asserted that a delayed age of one's sexual debut could be a useful way to increase the effectiveness of HIV behavioral strategies for reducing HIV transmission among at-risk populations, it has yet to be explored as a protective factor among African MSM [7].…”

Theory, Analysis, Social Justice, and Criminalizing HIV Transmission: A Commentary on Lehman and Colleagues (2014)

“…As Coates et al [29] point out, social justice is necessary to optimize public health efforts. Lehman and colleagues conclude their report by suggesting that state legislatures reconsider HIV criminalization law through the lens of the current science of HIV transmission and treatment.…”