Special Topic: Beyond Condoms: Strong Programs Key to Success

Condoms are necessary for the success of HIV/AIDS prevention efforts, but they are by no means sufficient. They need to be supported with strong political leadership, appropriate funding, sound policies, and well-coordinated programs.

A supportive policy and social environment is key to the success of prevention strategies. Governments, in collaboration with a civil society that is well attuned to their communities’ cultural nuances, need to provide such an environment. By addressing the policies, cultural practices and economic conditions that increase people’s vulnerability to HIV infection, governments and societies can encourage individuals’ behavior change.

Changing attitudes and behavior is at the heart of HIV prevention. A successful strategy establishes the conditions and environment that allows people to protect themselves against infection, educates about sexual health and HIV transmission, and emphasizes abstinence and delaying the onset of sexual activity for those who are not sexually active. It encourages having fewer sexual partners, provides the skills to negotiate safer sex, and promotes condom use for those who are sexually active. A good prevention strategy also treats STIs, provides HIV counseling and testing for those who want to know their HIV status, prevents mother-to-child transmission by protecting the mother from infection, and treats infected mothers. It should also address traditional practices, such as female genital cutting, that increase the risk of HIV infection. Strategies should also be in place to ensure the safety of blood supplies and to address injecting drug use.

Following are three elements key to the success of HIV/AIDS prevention programs.

Act Early, Act Now

Investing now in prevention activities and expanding awareness of and access to condoms, by all possible means, can minimize the need for huge financial investments later in care and treatment of persons living with HIV/AIDS. Early action also lessens the social and economic disruption caused by higher mortality rates among adults in their most productive years.

Among developing countries, there are few examples of intervention early enough to reduce risk from the full onset of AIDS. Where early action was taken, however, prevention has been more successful and the effects of the epidemic were reduced from what they could have been. Senegal,Thailand, and Brazil are notable examples. In Cambodia, for example, serious prevention efforts got underway in the mid 1990s. With a focus on reducing high-risk behavior among men and increasing condom use, the Cambodian program is seeing evidence of success. The HIV infection rate fell from 3.9 percent in 1997 to 2.8 percent in 2000, while HIV prevalence among pregnant women declined from 3.2 percent to 2.3 percent over the same period.

Target Prevention Interventions

Finding ways to prioritize prevention interventions is strategically important for long-term public health, especially where resources are limited. Priorities are determined by the stage and pattern of the epidemic in population subgroups and on the country’s financial resources and capacity for implementation. At the beginning of an epidemic, it is important to target high risk groups and individuals to prevent a localized epidemic from spreading into the general population. As the epidemic develops, other strategies should address appropriate issues and groups.

Scale Up Successful Efforts

Small-scale, successful HIV prevention activities abound, but national level coordination has been achieved in only a few countries. Expanding the coverage, impact, quality and sustainability of existing operations entails building on the experience of successful small-scale programs, and adapting them to the demands of a wider community. Leadership and sound administrative systems are needed for effective scaling up of programs.

Though such efforts remain largely undocumented, Uganda is a good example of a successful, large-scale multi-sectoral response, in which condoms were a key component. Uganda has cut infection rates in half, in recent years, with education, testing, counseling, and condom promotion. Government action involved multiple ministries, while other groups in society — including religious leaders and community development organizations — assisted in ways that made best use of their particular skills. Uganda focused on promotion of safer sex behaviors through condom marketing and distribution, radio and TV advertising, peer education, and use of people living with AIDS (PLWA) as educators. This broad-based approach made it easier to reach individuals at the grassroots level and contributed to a reduction in HIV infections among young pregnant women and adolescent girls. The significant increase in condom use probably contributed to declines in teenage pregnancies as well.

Sources:
UNAIDS. 2001. AIDS Epidemic Update: December 2001. Geneva: UNAIDS.

International HIV/AIDS Alliance. 2001. Expanding Community Action on HIV/AIDS: NGO/CBO Strategies for Scaling-up. Report of the third year of the “Community Lessons, Global Learning” collaboration between the International HIV/AIDS Alliance and Positive Action, GlaxoSmithKline.  London: International HIV/AIDS Alliance.

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