Behaviour change programmes have had little impact on HIV incidence
amongst girls and women in poorer countries
http://www.aidsmap.com/en/news/6AC9947E-A048-417D-94D4-1E6079A98EC1.aspMichael Carter, Wednesday, May 19, 2010
Behavioural change interventions to prevent sexual transmission of HIV
among women and girls in resource-limited settings have had limited
success, according to a systematic review published in the online
edition of AIDS and Behavior.
Only eight randomised controlled trials or prospective studies with a
control arm could be identified by the investigators. Moreover, only
two of these programmes reduced HIV incidence. Three other
interventions had an impact on HIV risk behaviours or the incidence of
sexually transmitted infections.
Approximately 50% of worldwide HIV infections are in women and girls.
However, the impact of HIV on women in the countries hardest hit by
HIV has been more severe, with 60% of HIV infections in sub-Saharan
Africa being in girls or women.
The development of female-controlled biomedical methods of HIV
prevention, such as microbicides, has been slow and disappointing.
Therefore HIV prevention for women and girls is reliant upon behaviour
change – for example, delayed sexual debut, a reduction in the number
of partners, and condom use. These methods of prevention are largely
controlled by male partners, and in many cases women and girls are
unable to insist on behaviour that could protect their sexual and
reproductive health.
Mindful of these circumstances, an international team of investigators
conducted a systematic review of behaviour change interventions to see
if they reduced either HIV incidence or HIV risk behaviours.
Randomised controlled trials or prospective studies with a control arm
conducted after 1990 was eligible for inclusion.
After an exhaustive literature search, the investigators were only
able to identify eight studies (reported in eleven research papers)
that met their inclusion criteria.
Six of the studies were conducted in Africa, one was carried out in
India, and one in Mexico.
A total of 42,000 women or girls were included in these studies, and
these people were followed for an average of 2.6 years.
The type of intervention varied from a single counselling session to
more extensive and long-term support.
Only two interventions had an impact on HIV incidence.
The first of these was a six-month programme of group education and
motivational sessions for female sex workers and brothel madams in
Mumbai, India.
The intervention for the sex workers consisted of the use of
motivational literature and videos, group discussions, and the use of
pictorial resources focusing on HIV and condom use. The women were
instructed how to use condoms correctly, and encouraged to educate
their clients about condom use.
Brothel madams were educated about the economic benefits and
importance of maintaining the good health of their sex workers.
HIV incidence was reduced by 67% in the intervention arm compared to
the control arm. However, the investigators noted that condoms and
lubricant were only provided to women in the intervention arm, and
were not given to the sex workers in the control group.
This intervention was also shown to reduce the incidence of both
syphilis and hepatitis B.
The second study was conducted in Uganda, and this showed that
attendance at an HIV study event in the previous year reduced HIV
incidence by up to 59%. Incidence of herpes simplex type-2 (HSV-2) was
also reduced by 45%.
Three other interventions were successfully reduced the incidence of
sexually transmitted infections, but not HIV. Condom use higher in the
intervention arm in the Mexican study than in the controls (27 vs 18%,
p < 0.01).
"This review has highlighted the reality that current behavior change
interventions, by themselves, have been limited in their ability to
control HIV infection in women and girls in low- and middle-income
countries," comment the investigators.
The investigators highlight that women and girls often have little
control over their sexual and reproductive health and in many cases
are unable to insist on condom use.
A "combination" approach to prevention is advocated by the study's
authors, one that addresses both behavioural and biomedical risk
factors.
They write, "the diminishing hope that a single behavioral or
biomedical prevention intervention will be sufficient to address the
growing HIV pandemic has heralded a programmatic shift towards
combination HIV prevention programming."
Reference
McCoy SI et al. Behavior change interventions to prevent HIV infection
among women living in low and middle income countries: a systematic
review. AIDS Behav, online edition, DOI 10. 1007/s10461-009-9644-9,
2010.
--
Truth resides in every human heart, and one has to search for it there, and to be guided by truth as one sees it. But no one has a right to coerce others to act according to his own view of truth. - Mohandas Gandhi
You received this message because you are subscribed to the Google
Groups "SAFE - Social Action Foundation for Equity" group.
To post to this group, send email to
socialactionfoundationforequity@googlegroups.com
To unsubscribe from this group, send email to
socialactionfoundationforequity+unsubscribe@googlegroups.com
For more options, visit this group at
http://groups.google.co.in/group/socialactionfoundationforequity?hl=en?hl=en-GB