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Behaviour change: mind the gap please!

The strategy of avoiding risky behaviours that could lead to HIV infection is predictably receiving both positive and negative press at the ICASA currently under way in Cape Town.

High profile if cautious endorsement came from the Director of the Global Fund, Mark Dybul. Addressing a UNAIDS session on scaling up treatment coverage on 9 December, Dybul said every demographic health survey of the last 10 years showed behaviour change among youth and added that there was evidence of “remarkable reductions” of HIV incidence among this age group.

However Dybul voiced caution about taking this data at face value, “because we can’t prove it led to reduction”, and rates of new HIV infections among youth remain high. He said the data “challenges us a bit” and that we need to find out more “because we can’t answer the question where to invest smarter in prevention until we do”.

Talking about behaviour change as a strategy of HIV prevention is bound to have its pitfalls, not least because what one person means by the term could be quite different from what someone else thinks.

One of the AJAN representatives at ICASA is Time Baluwa from the Jesuit AIDS Project in Zimbabwe, which for years has worked to prevent HIV among young people through value-based education, peer support and leadership training.

Time describes behaviour change as “an integral process of identifying risky behaviours that make one susceptible to HIV infection and replacing them with healthy behaviours that avoid HIV”. He emphasises “integral”, because HIV cannot be tackled in isolation of other personal and social development issues.

Attending sessions focused on youth at ICASA, Time felt that behaviour change was discussed only superficially and not with the attention it deserves.

“During one session, someone said behaviour change has failed when we look at statistics,” he said. “But if some behaviour change programs failed, is it because they were not conceived and implemented properly or because they were done well and failed anyway?”

Time believes many programs don’t deliver because they have a big gap between information and action, a gap that needs to be filled by education as formation. “People give information and expect action to follow. When this doesn’t happen, they say behaviour change has failed. But information doesn’t automatically equate with action. Education is needed in-between, to direct the actions of young people, and this is the gap we need to look into.”

Another drawback is a quick-fix approach that simply doesn’t work: “You don’t change someone’s behaviour in a three-day camp.” From his experience at JAP, Time believes that behaviour change does work but needs plenty of investment in terms of time and support to allow young people to absorb learned behaviours.

An easier way of getting quick results in HIV prevention would be to use condoms, an approach that is being flaunted by the Condomize Campaign at ICASA, no expense or effort spared.

Sometimes the two strategies – behaviour change and condom use – are pitted against one another although most proponents of prevention strategies now advocate a “combination approach” that draws on different means.

After attending another session that recommended condoms as an effective means of prevention for young people in secondary schools, Time did compare the two strategies, drawing on his experience and on a key concept of Catholic social teaching.

“Condom use is a behaviour in itself, just as abstinence is,” Time said. “Perhaps the question to ask is: what is the greater good? Many say condom use is good – and we are not disputing the scientific evidence here – but where does the greater good lie? We want young people to choose the best decisions to live a happy and healthy life, not just to avoid HIV.”

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