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Leading AIDS Experts Urge Greater Focus on Behavior-Change Programs to Prevent HIV

Report: Hundreds of Studies Show that Programs to Curb Unsafe Sex and Drug Use are Highly Effective, but Often Overlooked in Global AIDS Response

MEXICO CITY, Aug. 5 /PRNewswire/ -- In a new report released today, an international panel of AIDS experts calls on global leaders to aggressively expand HIV prevention programs aimed at reducing high-risk behaviors, including unsafe sex and drug use. Citing hundreds of clinical trials and observational studies, the report concludes that behavior-change programs are highly effective for preventing HIV, but do not currently reach enough people to have a decisive impact on the epidemic.

The report, released by the Global HIV Prevention Working Group, notes that while many are skeptical about the effectiveness of behavioral HIV prevention programs, these interventions have been central to all national efforts to reduce HIV infection rates. Review of national prevention programs that include evidence-based behavior-change strategies shows that they have been associated with an overall 50%-90% decline in HIV infections in key populations.

"Behavioral HIV prevention works. Some have been pessimistic that it's possible to reduce HIV risk behaviors on a large scale, but this concern is misplaced," said Dr. Helene Gayle, co-chair of the Working Group, and president and CEO of CARE USA. "We should not confuse the difficulty in changing human behavior with the inability to do so."

The report, titled Behavior Change and HIV Prevention: (Re)Considerations for the 21st Century, acknowledges that it is challenging to design effective behavior-change programs and monitor their impact, and calls for additional research in these areas. At the same time, the report emphasizes that there is clear evidence that expanding prevention, including behavior-change programs, could save millions of lives -- projections commissioned by the Working Group show that expanding all scientifically proven HIV prevention strategies could cut global rates of new HIV infections in half by 2015.

"Unanswered questions shouldn't stop us from supporting proven programs," said Dr. David Serwadda, co-chair of the Working Group, and dean of the School of Public Health at Makerere University in Uganda. "In the 21st century, reducing risky sex and drug use is absolutely essential for slowing HIV, especially since a vaccine or microbicide could take far longer than hoped."

Report Identifies Key Elements of Successful Behavior-Change Programs

The Working Group report points to diverse examples of success in reducing HIV risk behaviors, including national programs in Uganda, Thailand, Australia, and Brazil. While effective behavior-change programs can take many different forms, they share several common elements, including:

-- Combination prevention: Successful HIV behavior-change programs deliver a combination of scientifically proven risk-reduction strategies -- such as one-on-one counseling, small-group programs, and community education to encourage people to adopt safer sexual behaviors and avoid risky drug use.

-- Access: Successful behavior-change programs achieve sufficient coverage, intensity, and duration to have a long-term impact.

-- Tailored strategies: The most effective behavior-change strategies address the main drivers of HIV transmission, and are tailored to specific needs and circumstances of groups at high risk.

-- Community support: Successful behavior-change programs have strong community involvement and support.

"When it comes to reducing HIV risk behaviors, a 'one-size-fits-all' approach doesn't work," said Dr. Salim Abdool Karim, pro-vice chancellor for research at the University of KwaZulu-Natal in South Africa, and a member of the Working Group. "That said, the successful efforts we reviewed share striking similarities -- they deliver a combination of proven strategies, reflect local needs and circumstances, and are widely accessible to those at risk."

Greater Leadership, Resources Needed to Strengthen Behavior-Change Efforts

The Working Group report provides detailed recommendations to help rapidly expand and strengthen HIV behavior-change programs globally. Key recommendations include the following (see the report for the complete list):

-- International funders -- including donor-country governments, private foundations, and the Global Fund to Fight AIDS, TB, and Malaria -- should meet UNAIDS's call for at least $11.9 billion to be spent annually by 2010 to expand HIV prevention efforts, including behavior-change programs targeted to groups at high risk.

-- Leaders in developing countries seriously affected by AIDS should work closely with UNAIDS and the World Health Organization to develop aggressive national HIV prevention plans that are based on the latest scientific evidence, tailored to local needs, and well integrated with HIV/AIDS treatment programs.

-- Researchers should undertake additional studies to address limitations in knowledge about how to best implement HIV behavior-change programs. For example, more research is needed on how to translate findings from controlled prevention trials into "real world" settings, how to best reach high-risk groups with prevention services, and how to sustain behavior change for the long term.

The Global HIV Prevention Working Group is a panel of more than 50 leading public health experts, clinicians, biomedical and behavioral researchers, advocates, and people affected by HIV/AIDS, convened by the Bill & Melinda Gates Foundation and the Henry J. Kaiser Family Foundation. The Working Group seeks to inform global policy-making, program planning, and donor decisions on HIV prevention, and to advocate for a comprehensive response to HIV/AIDS that integrates prevention, treatment, and care. More information and Working Group publications are available at

SOURCE Bill & Melinda Gates Foundation
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