Change In Sexual Behaviors Needed To Curb Spread Of HIV In Africa, Some Health Experts Say

An increasing number of health experts believe that there is a need to change sexual behaviors, including a reduction in the number of sexual partners, to reduce the spread of HIV in Southern Africa, the Financial Times reports. Although a large amount of funding is directed toward HIV prevention programs, "far less effort has gone into persuading people to change their" sexual behaviors, according to the Times. "Prevention has concentrated on testing, condoms, safe blood and mother-to-child transmission -- things that fall easily off bureaucrats' lips," Derek von Wissell -- head of Nercha, Swaziland's official National Emergency Response Council on HIV/AIDS -- said, adding, "Behavior change is the difficult side. It needs a whole societal shift." Recent efforts in Swaziland and other African countries "reflect a new determination to tackle" behavior change -- a "sensitive subject" that has "long been politicized," the Times reports. In the U.S. and other countries, the debate surrounding HIV prevention has become "polarized" around which element of the ABC prevention method -- which stands for abstinence, be faithful and use condoms -- "should receive priority," according to the Times. "There was an immediate polarization between those saying condoms were evil and those who argued that only condoms were good," Daniel Halperin of the Harvard School of Public Health said. Halperin and some other public health experts have said that while all three elements of the ABC method are important, changing sexual behavior and partner reduction efforts have been the "neglected middle child" in ABC. Although condom use has been central to reducing the spread of HIV in countries like Brazil, Cambodia and Thailand, Ambassador Mark Dybul -- who serves as the U.S. global AIDS coordinator and administers the President's Emergency Plan for AIDS Relief -- said that a decrease in the number of men visiting commercial sex workers also contributed to the reduction in HIV cases. "Applying lessons (of condom use) from a concentrated epidemic to a region where there is a generalized epidemic was bordering on scientific insanity," Dybul said, adding, "We have not listened enough to Africans. It is tough to find one who doesn't say, 'A, B and C is what we need.'"

Movement Toward Behavior Change?
Although there is "no single or satisfactory explanation" for why HIV prevalence is higher in Southern Africa than the rest of the world, a "growing body of evidence points to the predominant role of one aspect of sexual behavior" -- that men and women often have "concurrent sexual partners over months or years," the Times reports. This practice contributes to the spread of HIV because the virus' ability to be transmitted peaks during the weeks after a person becomes infected, meaning that an HIV-positive person with multiple partners can spread the virus quickly to others, according to the Times. In addition, long-term sexual partners are less likely to use condoms -- increasing the likelihood that if one partner is HIV-positive, the virus will be transmitted to the other. The effect of such behaviors on the spread of HIV is beginning to be acknowledged, according to the Times. A report presented last year at a conference convened by the Southern African Development Community examined instances in which the number of HIV cases appeared to be decreasing and linked these reductions to successful behavior change programs in countries such as Kenya, Uganda and Zimbabwe (Jack, Financial Times, 1/18).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.