Prevention of HIV/AIDS in South Africa: a review of behaviour change interventions, evidence and options for the future

IT IS UNLIKELY THAT AN EFFECTIVE VACCINE against HIV infection will be wide ly available in the next 10 years, and even less likely that a cure will be found in this time. Affordable therapies that can be widely used are still not available and so behaviour change remains the only viable means of lim iting the further spread of HIV infection. Currently, about one in four wom en attending ante-natal clinics in South Africa is infected with HIV, which translates into about 10% of the entire population. Women aged 20 to 30 ye ars are the worst-affected group in South Africa, and the incidence of infe ction is highest in women between 15 and 30 years of age. Studies around th e world have shown that behaviour interventions including information, educ ation and communication programmes, condom promotion and behaviour change i nitiatives that encourage people to reduce the number of their sexual partn ers can bring about a reduction in high-risk sexual behaviour. Delaying the age of sexual initiation and abstaining from sex have also met with succes s, specifically in young people. In South Africa, public education through mass media has contributed to high levels of awareness about HIV/AIDS. In a ddition, some interventions have been targeted at specific risk groups. The continuing increase in infection rates suggests that these efforts have be en too limited or perhaps not effective on a broad enough scale to achieve a significant public health impact. Future efforts should target the highes t risk groups, especially among women, with an emphasis on interventions th at develop negotiation and decisionmaking skills, address gender imbalances , and locate HIV prevention in the context of people's lives. This paper re views the available evidence concerning behaviour change programmes and eva luates their effectiveness in South Africa. Criteria are proposed for innov ative behavioural prevention strategies and priorities in future research.