STD Prevention: Behavior Change

Safer Sex - Problems of Safer Sex Promotion

Political Problems - Getting the facts
Governments make a serious mistake if they launch prevention campaigns without first ascertaining the actual epidemiological situation. After all, it makes little sense to blanket the nation with AIDS messages as long as most infections are still due to specific behaviors in a limited part of the population. The first order of business should therefore be to find out who gets infected where, how, and by whom. Once it is known who exactly is at risk and why, very specific messages can be directed at clearly defined groups, thus increasing the chance of stopping the epidemic in its early stages. For this, it is necessary to offer free anonymous testing and to interview all those found to be infected. Again, these interviews must be conducted anonymously by independent reserarchers, and the answers must be used only for statistical purposes. They must not become part of any person’s medical record.
If, on the other hand, both the tests and the interviews are conducted by the same doctor who then records the results in an easily identifiable file, many women and men at risk will avoid getting tested. Those who do end up in the doctor’s office will simply lie, especially if they became infected through homosexual contact, intravenous drug use, or other stigmatized behaviors. As a result, the statistics about HIV transmission become misleading, and an early opportunity to control the epidemic through targeted intervention is lost.

Examples of possible early scenarios and targeted responses
If anonymous tests and interviews in a certain country should reveal that their own or foreign soldiers are a major source of HIV infection, it would be useful to target them specifically. If it should be found that bisexual contacts are an important factor in HIV transmission, it would be useful to distribute appropriate materials. If, on the other hand, an increased use of “party drugs” in discos contributes to unprotected sexual contacts, specific guidelines are needed adressing this issue. Finally, it is always necessary to deliver the message of “safer sex” to those who already know that they are infected. The materials above were developed in Germany (the first three from the left) and France (on the right). They are shown here only for the purpose of illustration. They are not indicative of the early or current transmission patterns in these two countries.