Reassessing HIV prevention

School of Public Health, University of California at Berkeley, Berkeley, CA 94720, USA.
Science (Impact Factor: 33.61). 06/2008; 320(5877):749-50. DOI: 10.1126/science.1153843
Source: PubMed


The largest investments in AIDS prevention targeted to the general population are being made in interventions where the evidence for large-scale impact is uncertain.

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Available from: Richard G Wamai
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    • " 2 treatment, its existing prevalence in West Africa and among African Muslims, social acceptability, and its continuous effect with every act of intercourse (Anonymous, 2007; Halperin and Epstein, 2007; Potts et al., 2008; Weiss et al., 2008). "
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    ABSTRACT: Background: The failure to stem HIV in sub-Saharan Africa and the unique epidemiological modes of infection within this region have demonstrated that unique strategies for combatting the virus are required. This review article discusses why international AIDS campaigns in sub- Saharan Africa have largely been unsuccessful, and what, if any, strategies have worked.Methods: Articles were compiled using Web of Science and Google Scholar search ngines.Results: Inspired by past successes in the West and in Southeast Asia, Western AIDS initiatives have attempted to replicate these results within the African continent through ‘risk reduction’ approaches, vying to reduce the probability of HIV transmission per coital act via physical or biochemical barriers such as condoms, male circumcision, antiretroviral therapy, post-exposure prophylactic drugs, and treatment of sexually transmitted infections. However, more than three decades of research have demonstrated that the most successful strategies were African-inspired, relied on local resources with minimal Western support, culturally relevant, and used social engineering programs that dismantled networks of sexual relationships by promoting the practice of abstinence, reducing the number of sexual partners, discouraging multiple and concurrent relationships, delaying sexual debut, and maintaining mutually monogamous relationships.Conclusion: Known through the mnemonic ‘ABC’ (Abstinence, Be faithful, Condoms), this strategy was first implemented in Uganda, yielding remarkable successes both in Uganda and thereafter in other African nations in stemming HIV. AIDS agencies should support and encourage programs that use this culturally sensitive, low cost, and effective strategy.
    Preview · Article · Dec 2015 · African Journal of Infectious Diseases
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    • "Uganda adopted a “Zero Grazing” campaign in the 1980’s, where having concurrent partners was discouraged. This campaign showed a 50% reduction in the number of people reporting casual and multiple partners between 1989 and 1995 [58,95]. It is also believed that partner reduction and fidelity are the main behavioral changes responsible for the decline in Kenya’s HIV infection rates. "
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    ABSTRACT: Thirty years since the discovery of HIV, the HIV pandemic in sub-Saharan Africa accounts for more than two thirds of the world's HIV infections. Southern Africa remains the region most severely affected by the epidemic. Women continue to bear the brunt of the epidemic with young women infected almost ten years earlier compared to their male counterparts. Epidemiological evidence suggests unacceptably high HIV prevalence and incidence rates among women. A multitude of factors increase women's vulnerability to HIV acquisition, including, biological, behavioral, socioeconomic, cultural and structural risks. There is no magic bullet and behavior alone is unlikely to change the course of the epidemic. Considerable progress has been made in biomedical, behavioral and structural strategies for HIV prevention with attendant challenges of developing appropriate HIV prevention packages which take into consideration the socioeconomic and cultural context of women in society at large.
    Full-text · Article · Dec 2013 · AIDS Research and Therapy
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    • "The increasing evidence of the linkages between transactional sex or multiple sexual partners and HIV has led to calls for greater investment in prevention efforts that try to address these behaviours, particularly among youth [65,66]. Work on understanding the determinants and associations with these behaviours, from the structural to individual level, is therefore imperative for HIV and STI prevention efforts. "
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    ABSTRACT: Background Ethnographic evidence suggests that transactional sex is sometimes motivated by youth’s interest in the consumption of modern goods as much as it is in basic survival. There are very few quantitative studies that examine the association between young people’s interests in the consumption of modern goods and their sexual behaviour. We examined this association in two regions and four residence zones of Madagascar: urban, peri-urban and rural Antananarivo, and urban Antsiranana. We expected risky sexual behaviour would be associated with interests in consuming modern goods or lifestyles; urban residence; and socio-cultural characteristics. Methods We administered a population-based survey to 2, 255 youth ages 15–24 in all four residence zones. Focus group discussions guided the survey instrument which assessed socio-demographic and economic characteristics, consumption of modern goods, preferred activities and sexual behaviour. Our outcomes measures included: multiple sexual partners in the last year (for men and women); and ever practicing transactional sex (for women). Results Overall, 7.3% of women and 30.7% of men reported having had multiple partners in the last year; and 5.9% of women reported ever practicing transactional sex. Bivariate results suggested that for both men and women having multiple partners was associated with perceptions concerning the importance of fashion and a series of activities associated with modern lifestyles. A subset of lifestyle characteristics remained significant in multivariate models. For transactional sex bivariate results suggested perceptions around fashion, nightclub attendance, and getting to know a foreigner were key determinants; and all remained significant in multivariate analysis. We found peri-urban residence more associated with transactional sex than urban residence; and ethnic origin was the strongest predictor of both outcomes for women. Conclusions While we found indication of an association between sexual behaviour and interest in modern goods, or modern lifestyles, such processes did not single-handedly explain risky sexual behaviour among youth; these behaviours were also shaped by culture and conditions of economic uncertainty. These determinants must all be accounted for when developing interventions to reduce risky transactional sex and vulnerability to HIV.
    Full-text · Article · Mar 2013 · Globalization and Health
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