Prevention interventions the key to reducing HIV transmission
Guyana Chronicle
November 24, 2002

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THE global scourge of HIV/AIDS continues to take its toll, even as we enter the third decade of this deadly disease. Since 1981 when the virus was identified, about 60 million people contracted the infection. Further, HIV/AIDS is the leading cause of death in Sub-Saharan Africa, and globally, it is the fourth leading executioner.

At December 1996, about 29.4 million adults and children had contracted the HIV infection, and 8.4 million of them developed AIDS, according to the World Health Organisation. Worldwide, about 40 million people today are nursing the HIV infection. Young adult men and women are more susceptible to new HIV infections in the poorest countries. About 33 per cent of people living with HIV/AIDS are in the age group 15 through 24.

In the Caribbean, 420,000 adults and children are living with HIV/AIDS, 60,000 are new infections, and 50 percent of HIV+ adults are women. In fact, when compared to the rest of the world, both Sub-Saharan Africa and the Caribbean have the highest proportions of HIV+ women. In the Caribbean, the primary modes of HIV transmission are heterosexual transmission and sexual transmission among men having sex with men. These statistics are drawn from UNAIDS/WHO.

According to UNICEF, worldwide, about 800,000 infants contracted the HIV infection, largely through mother-to-child transmission in 2001.

An infant born to an HIV-positive mother has a 25 to 35 percent probability of contracting the infection during childbirth or through breastfeeding, according to UNICEF.

UNICEF reported that recent studies demonstrated that a mother-to-child intervention package, including the use of antiretroviral drug treatment at the end of pregnancy, can slow down HIV transmission by 50 percent.

In Guyana, the cumulative total of reported cases of AIDS as of December 2001, were 1,615, with deaths totaling 377.

In the absence of a cure for eliminating the AIDS virus, behavioural prevention interventions today become the only means to reduce the spread of HIV transmission and reduce new HIV infections.

However, HIV infection is preventable through behaviour change. Therefore, efforts exerted to prevent AIDS depend on an understanding of the factors that affect behavior and behavior change.

However, significant social and psychological stressors have marred HIV prevention intervention outcomes over the years. The time may have now come for interventions to break away from the traditional models of behaviour modification. Interventions now have to redirect their perspective toward shared safety where the focus is on the sexual behaviours of all sexual partners.

Fishbein (1997) argues that an understanding of why people have risk behaviours could result in the development of effective interventions to change that behaviour. The three theories that greatly impacted AIDS intervention research, according to Fishbein, are the Health Belief Model, the Social Cognitive Theory, and the Theory of Reasoned Action.

The three theories are quite adequate to predict behaviours. For instance, the probability is high that a given behavior will be effected, if the following conditions are present:

The person has a strong intention or commitment to perform the behaviour

The person possesses the skills and abilities needed to perform this behaviour

The person faces no environmental constraints to perform this behaviour

The person has the belief that performing this behaviour will result in positive outcomes

The person accepts the norms regarding this behaviour, that is, norms that are accepted by people important to him

Fishbein points out that we need to identify all these factors that strongly influence a given behaviour, and then apply this information to design behavioural interventions. But is there a consensus in the Caribbean on what interventions to use?

Consensus statement on interventions
A few years ago I attended the National Institutes of Health (NIH) Consensus Development Conference on Interventions to Prevent HIV Risk Behaviours at the NIH in Maryland, USA.

This Conference attempted to review what is known about behavioural interventions that are effective with different populations in different settings for the following modes of transmission: sexual behavior, mother to child transmission, and substance abuse.

This Conference addressed these questions:
1. Identify the behaviours and contexts that place individuals/communities at risk
2. Identify the individual/community-based methods of intervention that reduce behavioural risks

3. Determine whether or not reduction in behavioural risks lead to HIV reduction

4. Determine how risk-reduction protocols can be implemented effectively

5. Identify the research urgently needed.

There is consensus that behavioural interventions today are still the most effective method to reduce the spread of HIV infection and slow the growth of new infections.

Health policy makers in the Caribbean may need to consider developing a comprehensive consensus statement on interventions to prevent risk behaviours, to reduce the spread of HIV transmission, and to lower the rate of new infections. Caribbean policy makers need to agree now on what the ‘best practices’ prevention interventions are!! History and time are not our side amid this deadly disease!!

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