Rethinking HIV/AIDS Prevention
Posted by ryanlindsay on May 22, 2008
In a recent article published in science magazine, HIV/AIDS prevention is reconsidered. I thought this was fascinating, but if you want the quick version:
- Condom distribution works for certain demographics: particularly high risk groups such as sex workers and men who have sex with men (MSMs).
- Abstinence is efficacious but not effective. This means that abstinence prevents transmission of HIV/AIDS, but as a prevention technique has only been shown effective at times with youth under 20. Most new cases of HIV/AIDS are from already sexually active individuals in their 20’s and 30’s.
These two aspects of HIV/AIDS prevention have their place, but in order to have a widespread epidemiological impact on heterosexual adults (the vast majority of HIV/AIDS cases in the world) two less-known, but proven prevention strategies should be considered:
- Male circumcision – Over 45 observational, biological, and other studies from the last 20 years have shown that MC significantly reduces the risk of heterosexual HIV infection.
- Reducing multiple sexual partnerships – Another preventive measure that has had a powerful impact and that could have even greater effect, if it were more widely and assertively promoted, is partner reduction.
The following graph shows that funding for proven, effective measures like promoting and provision of male circumcision is very disproportionate.
Source:
Malcolm Potts, Daniel T. Halperin, Douglas Kirby, Ann Swidler, Elliot Marseille, Jeffrey D. Klausner, Norman Hearst, Richard G. Wamai, James G. Kahn, and Julia Walsh. .
Science 9 May 2008: 749-750.
Utah Valley Global Health Group 
chads said
Thanks for the summary and link, Ryan. Certainly an important, controversial, and politically-charged topic. I hope that all parties agree that decisions should be based on evidence as opposed to emotion and/or ideology (or at least that all should be up front about ideology being their motive). I’ll put it on my “to read” list.
ryanlindsay said
Chad, I think you’re right, definitely important, controversial and political. I think what is most important is that people understand the population their working with. I’ve done the whole pass-out-the-free-condom thing to married heterosexuals in Mozambique and for me it’s not that it didn’t feel right, it just didn’t feel effective. I think an effort to reduce multiple sexual partnerships may have been more effective and viable intervention for that population.
Like you said, the key for NGOs and others in the field would be to 1) find evidence-based interventions tailored to your population and/or 2) use a participatory approach and find what is culturally appropriate where they are working.
This article is definitely considering the macro scale and probably concerns global health policy more than anything else. I am curious to know if anyone has seen or had experience with effective programs that aim to reduce the number of sexual partners?
Kirk Dearden said
I worked on a project in El Salvador–aimed at the police force–to increase condom use and reduce the number of sexual partners. Folks interested in reading about it can go to http://www.changeproject.org. My impression is that it is much more difficult to reduce the number of sexual partners than it is to pass out condoms–though the former may be more effective.
As for the evidence regarding sexual abstinence programs, especially among youth, readers may be interested in the following article:
John S Santelli, Mary Ott Maureen Lyon, Jennifer Rogers, Daniel Summers, Rebecca Schleifer. “Abstinence and Abstinence-Only Education: A Review of US Policies and Programs.” J Adolescent Health 38 83-87 2006
While the article is focused on the US, it does suggest that evidence of impact for abstinence programming is VERY thin–regardless of what we THINK may be appropriate.
Unshaped said
Somehow i missed the point. Probably lost in translation 🙂 Anyway … nice blog to visit.
cheers, Unshaped!!
Jay said
Even though I have been introduced to some programs dealing with the prevention of the transmission of HIV/AIDS I still have no idea of what is the best method. Before I had been exposed to the effectiveness of different methods I would think how sad it was that people were preaching condoms and not abstinence. Now I understand that abstinence programs are not effective but condoms still seem just a short term fix that eventually dies out. I agree that partner reduction would be a great fix, but getting behaviors to change from such a program might be as effective as programs that teach abstinence and being faithful in marriage. The male circumcision idea, however, might be a good idea but involves the difficult task of changing many traditional practices.