HIV and risk behaviour - Risk compensation: the Achilles' heel of innovations in HIV prevention?

Office of HIV/AIDS, United States Agency for International Development, Washington, DC 20523-3700, USA.
BMJ (online) (Impact Factor: 17.45). 04/2006; 332(7541):605-7. DOI: 10.1136/bmj.332.7541.605
Source: PubMed
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Available from: James D Shelton, Feb 24, 2014
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    • "Kalichman (2013) has noted that treatment as prevention , an epidemiological projection tool, is being used by individuals to make important health decisions. For example, in what has been termed 'risk compensation' (Cassell et al., 2006) some men are engaging in more condomless sex because of their viral load (Kalichman et al., 2015). Recently, an event was held in Vancouver, Canada billed as the 'Undetectable Party: For Undetectable Guys and Guys Liking Undetectable Guys', where attendees could wear bracelets that read 'undetectable' or 'undetectable friendly'. "
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    ABSTRACT: The global response to managing the spread of HIV has recently undergone a significant shift with the advent of ‘treatment as prevention’, a strategy which presumes that scaling-up testing and treatment for people living with HIV will produce a broader preventative benefit. Treatment as prevention includes an array of diagnostic, technological and policy developments that are creating new understandings of how HIV circulates in bodies and spaces. Drawing on the work of Michel Foucault, we contextualize these developments by linking them to systems of governance and discursive subjectivation. The goal of this article is to problematize the growing importance of viral suppression in the management of HIV and the use of related surveillance technologies. For people living with HIV, we demonstrate how treatment-as-prevention’s emphasis on individual and collective viral load is transforming the performative dimensions of embodied risk, affect, subjectivity and sex.
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    • "The aforementioned transfer of burden of injury and death from belted passengers to non-belted passengers, cyclists, and pedestrians, serves as a fourth example. Compensatory behaviours is a likely explanation for the failure of risk reduction approaches in Africa: If the use of risk reduction tools such as antiretroviral therapy and condoms reduce the perceived lethality of HIV or risk of exposure to HIV per coital act, then these tools may inadvertently cause harmful behaviours to emerge that negate the effects of these tools or may even paradoxically result in further infections (Cassell et al., 2006; Hearst and Chen, 2004; de Irala and Alonso, 2006; Richens et al., 2000). As Cassell and colleagues (2006) have argued, the protective benefits of promoting condoms and other risk reduction tools could thus be " attenuated at the population level and could even be offset by aggregate increases in risky sexual behaviour " (p. "
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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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    • "ision could reduce the risk of HIV infection so that the use of condoms might only be necessary to avoid pregnancy . These findings are important because if men have more frequent sex without condoms , or are less motivated to use condoms to prevent pregnancy or other STIs , the protective benefits of circumcision may be substantially undermined ( Cassell et al . 2006 ; Thompson , Thompson , and Rivara 2001 ) . There are important limitations to our findings . Men in the focus groups were part of a larger home - based counselling and testing study and had received messages about VMMC before being part of the study . Additionally , data was collected within focus groups in which men were asked to arti"
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    ABSTRACT: While the uptake of voluntary medical male circumcision (VMMC) is increasing, South Africa has only attained 20% of its target to circumcise 80% of adult men by 2015. Understanding the factors influencing uptake is essential to meeting these targets. This qualitative study reports on findings from focus-group discussions with men in rural KwaZulu-Natal, South Africa, about what factors influence their perceptions of VMMC. The study found that VMMC is linked to perceptions of masculinity and male gender identity including sexual health, sexual performance and pleasure, possible risk compensation and self-identity. Findings highlight the need to understand how these perceptions of sexual health and performance affect men's decisions to undergo circumcision and the implications for uptake of VMMC. The study also highlights the need for individualised and contextualised information and counselling that can identify, understand and address the perceptions men have of VMMC, and the impacts they believe it will have on them.
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