AIDS Prevention: What Works?

In this opinion article, Daniel Halperin focuses on HIV/AIDS prevention as a central factor in turning back the incidence of the disease. He cites the fact that there is little evidence that knowing one's HIV-infection status leads to behaviour change that contributes to lowering the incidence of new infection. He then focuses on evidence-based possibilities for reducing the rate of HIV/AIDS infection.


The author supports his assertion about "know your status" campaigning with evidence from a randomised trial from Zimbabwe showing that there was an approximately 50% higher HIV incidence in the population that underwent HIV testing and counseling. Researchers, he states, have noted that some other studies similarly have found "disinhibition," or a worsening of behaviour, among people who learned that they were not infected. He states that those very recently infected with HIV are the most infectious to others, but they generally do not test positive since the test relies on the development of HIV antibodies. Further, research shows that in Tanzania, of the women who test positive and disclose their status to their male partners, a quarter suffer consequences such as violence or abandonment.


Halperin cites studies that show declines in HIV/AIDS rates occurring because of interventions addressing multiple partners:

"While approaches such as condom promotion (particularly in epidemics spread mainly by prostitution, as in much of Asia) are important, various studies have shown that virtually everywhere in Africa where HIV rates have fallen, these declines were preceded by steep declines in multiple partnerships. As Helen Epstein explores in her recent book on AIDS in Africa, such profound shifts in behavior have usually been accompanied by broad transformations in sexual and societal norms, such as the homegrown "Zero Grazing" campaign that took root in Uganda in the late 1980s."


Further, the author supports research-based HIV prevention measures like circumcision. He states that expanding family planning services could reduce unintended pregnancies, greatly decreasing the number of infected infants, as well as the number of children who eventually become orphans. He concludes by stating: "The most rigorous evidence suggests that there needs to be a vigorous expansion in Africa of behavior-change programs, for promoting partner reduction in particular, and greatly increased access to safe male circumcision."