Behaviour change happens but this is not necessarily the result of HIV prevention campaigns, top HIV clinician Professor Francois Venter declared in a debate today about whether HIV prevention actually works and how to measure this.
South Africa has 18% of the worldwide HIV epidemic and still has high rates of new infections despite efforts to prevent them, said Venter at the 5th SA AIDS conference.
Behaviour change campaigns are well resourced but not scientifically driven, he stated.
Venter said, for example, current HIV prevention campaigns are targeting multiple concurrent partnerships as a problem driving the HIV epidemic but a review of the research finds no evidence that these partnerships explain the high rates of infections in sub-Saharan Africa.
He said behaviour change needs to be driven by scientific evidence to be effective and that its track record so far was not convincing.
“Maybe we have not tried the right behaviour change,” said Venter, observing that clinicians do understand how hard it is to get patients to change health behaviours, such as stopping smoking or losing weight.
Dr Saul Johnson, the head of the Health Development Agency, and Richard Delate of Johns Hopkins Health and Education in SA both challenged Venter and painted a brighter picture of what’s going on with HIV prevention in SA.
Johnson said Venter was wrong that:
1) Communications programme don’t work. Johnson said there is evidence, for example with condom use, that they do;
2) If they did work South Africa wouldn’t have such a high HIV epidemic. Johnson said SA got off to a slow start and these efforts take a long time to get results;
3) Randomised controlled trials are needed to prove efficacy. They are not the best tool to assess this and are not implementable, he said;
4) SA must measure success by the rate of new infections. Johnson said lab tests are not 100% reliable and there may be better end points for measuring behaviour change; and
5) SA could get better value from funding “test & treat”. Johnson said that we are not going to be able to treat our way out of our epidemic given its scale.
Delate disputed that prevention campaigns have failed, saying that 80% of South Africans are HIV negative and “it is our job to keep them negative.”
The demand for HIV testing and condoms had increased in the last few years said Delate, suggesting this was linked to behaviour change campaigns.
He pointed out nobody had measured the rate of new infections at the start of the National Strategic Plan in 2006 so it’s hard to assess in 2011 whether it has succeeded in reducing incidence.
The goal was to cut new infections by half by 2011.
Johnson said: “We think we know what works, we just need to do it properly at this point.”