• There is abundant
evidence that prevention works, as shown in urban gay communities in
North America and Western Europe, among injecting drug users in Australia
and in heterosexual populations in countries like Brazil, Senegal, Thailand
• In the Ugandan
capital Kampala, for example, determined prevention efforts (as part
of a countrywide mobilization against AIDS) sent HIV prevalence rates
among teenage women plummeting from 28% in 1991 to 6% in 1998. Thailand’s
100% condom programme helped that country hold an epidemic in check
in the 1990s, while vigorous condom promotion appears to be paying off
in Cambodia, too.
of a country’s HIV prevalence rates, early investment in prevention
offsets later and much larger social and developmental costs. Investment
in prevention among young people is vital at any stage in an epidemic.
Basics of successful
• Essential for
success are public policies that boost and support prevention programmes.
The basic elements of successful prevention are communication (including
sexual health education) and behaviour change, the creation of an environment
that enables people to protect themselves against the virus, condom
promotion, HIV counselling and testing, and the treatment of sexually
programmes must concentrate on the main routes along which HIV spreads—by
addressing blood safety, mother-to-child transmission, injecting drug
use and sexual transmission.
• At a minimum,
prevention must form part of a comprehensive package of activities that
link prevention and care, and that slots into countries’ wider developmental
and public health strategies. Countries that successfully link prevention,
care and support programmes reap large social and economic benefits,
as Brazil, for example, has shown. Prevention of HIV also reduces prevalence
of other diseases, including sexually transmitted infections (STIs).
• Special emphasis
and sufficient resources must go toward protecting vulnerable populations
(such as sex workers, men who have sex with men and injecting drug users)
against HIV infection.
of their risk, all people must be provided with basic information and
the means to protect themselves.
Poverty and HIV
• HIV/AIDS affects
both rich and poor citizens in both developed and developing countries.
It is not a disease of poverty. But the epidemic does push people deeper
into poverty, making it more difficult for them to sustain or recover
their earlier livelihoods. That, in turn, can make people and their
families more vulnerable to HIV infection and to AIDS-related illnesses.
Poverty reduction can help limit people’s vulnerability to the epidemic.
• Economic insecurity,
displacement caused by conflicts and disasters, illiteracy, violence
and abuse, and social exclusion deprive millions of the ability to protect
themselves and others. In order to succeed, prevention programmes must
also enable people to choose safer life strategies. That calls for the
review of social and economic policies that entrench inequalities, discrimination
and social exclusion.
• The economic,
cultural and social conditions in which people live shape their options
and behaviour. Changing those conditions—and the attitudes of others—for
the better can enable people to build their lives around safer choices.
Getting it right
campaigns are reaching millions, but they still miss too many people,
especially the young. Recent surveys in 17 countries on three continents
showed that more than half the adolescents questioned could not name
a single method of protecting themselves against HIV/AIDS.
• Condoms, which
are essential to prevention, are being distributed in greater numbers
than ever before, but they are still not universally available. It is
estimated that six billion condoms are distributed each year, but that
many more (some estimates are as high as 24 billion) are needed to protect
populations from HIV and other sexually transmitted infections.
• The scope of
prevention programmes is often inadequate, creating situations where
activities do not reach population groups that are most vulnerable to
HIV infection. Marginalized groups (such as men who have sex with men,
sex workers, injecting drug users or prisoners) are more likely to be
ignored in prevention efforts.
• Effective prevention
is rooted in communities and often has its origins in small but successful
grassroots activities and activism. Community-based outreach work, peer
education and service provision are essential. Approaches that involve
opinion leaders and role models are just as important. The more successful
projects draw their inspiration and leadership from people living with
• Sturdy human
rights protection bolsters prevention programmes. The success of prevention
campaigns depends also on tackling stigma and discrimination. When the
epidemic is cloaked in shame and silence, people are less likely to
seek out and use preventive information, services and facilities.
A wider view of
and the means for protection must reach everyone, especially marginalized
sections of societies. Women and men (including young men and women)
must be able to apply the lessons and tools of prevention campaigns
in their lives. Prevention programmes therefore should link with efforts
to tackle the underlying factors that cause people to live in circumstances
or choose survival strategies that involve higher risks of infection.
• Improving access
to education, employment and livelihoods—especially for women—is a valuable
feature of effective prevention campaigns. Studies have also shown that
people with more education tend to be more likely to protect themselves
by using condoms during casual sex. The surveys showed that, especially
for girls, even a few years of added schooling translated into more
frequent condom use.
• In many societies,
HIV is transmitted also through practices and behaviour that may be
illegal or taboo. In those instances, legal sanction and hostile public
attitudes impede programmes aimed at reducing the danger of infection
for stigmatized people. That need not be the case. Thailand’s campaign
to ensure condom use in brothels, for instance, played a huge part in
that country’s ability to stabilize its HIV/AIDS epidemic.
sex work, homosexuality, drug use or the possession of condoms and injecting
needles could boost prevention efforts and limit the spread of HIV.
Likewise, sterner anti-rape laws and their stronger enforcement can
help reduce HIV transmission through coerced sex.
• The kinds of
prevention programmes needed may vary according to the situation in
each affected community, or may vary in intensity. In some cases, harm
reduction programmes for drug users might be a priority; in others condom
promotion and sexual health education might be most necessary. Changes
to inheritance laws in some countries could help ensure that widows
are not left destitute and forced to resort to sex work in order to
support themselves and their families.
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