Over the course of my time here in South Africa, I have learned that the behaviors responsible for the rapid spread of HIV in South Africa are the product of an intricately woven web of cultural and societal norms, withstanding gender inequalities and economic conditions, environmental factors, and political landscape. As such, I have also become aware that HIV prevention will not be completely successful unless both the high-risk behaviors and the underlying social problems further down in the causal chain are addressed by interventions. For example, although condoms may be available, gender inequalities at a structural level, in the form of male dominance and female economic dependence, stop people from using them.
Although it is obvious that societal issues first need to be addressed before people will change their behaviors, it is not obvious how to go about actually doing this. I feel the best way to at least start addressing these issues is through hybrid intervention strategies that incorporate prevention methods from behavioral, harm reduction and biomedical models. Examples of this type of intervention include voluntary counseling and testing, which aims to decrease transmission and stigma by making people aware of their status, condom marketing, which aims to change social norms about condoms by increasing access, knowledge, and social acceptance, and social mobilization, which aims to reduce stigma and drive the uptake of HIV prevention and treatment services through educating the community about HIV services and testing. I think these methods are particularly effective at a community level because not only do they make health services widely available, but also they educate people about why these services are necessary and, in doing so, increase exposure to HIV prevention materials and hopefully reduce stigma.
|Community Education and Mobilisation|
Cultural norms, and thus the groups of people that are primarily affected by HIV, differ in both South Africa and the United States. In the United States, people generally share the assumption that diseases are germ based. In South Africa, different cultures have different beliefs about what causes diseases. Thus, on a structural level, South African citizens and US citizens will have different attitudes towards western medicine, treatment, and understanding of disease. I believe that here in South Africa, educating the population about the biomedical model HIV and disease is crucial in ensuring that people will access and understand protocols and adhere to medication and prevention programmes. Various factors make it the case that HIV affects South African populations at large, and due to biological and societal factors, especially women. Therefore, it is important to reach whole communities with mass media campaigns and education about the biomedical model of disease.
There needs to be a change in the way that people view and think about HIV, and I feel that can happen through education about the biomedical model of disease. Prevention of Mother to Child Transmission (PMTCT) is of particular importance, since women do make up the majority of the population living with HIV. PMTCT is a perfect example of integrating behavioral and biomedical interventions, providing educational information on methods of passing HIV to the baby, providing treatment to both the mother and the baby, and ensuring good nutrition and health of the baby after birth. In the United States, the main intervention methods used will be different because of different at risk groups and cultural beliefs. In the US, HIV primarily affects key populations and high-risk groups, such as men who have sex with men (MSM) and people who inject drugs (PWID). I believe that harm reduction prevention methods, such as advocating for and providing condoms and needle exchange programs, are of particular importance to the US. Harm reduction is an important tool for HIV prevention because it addresses factors affecting individual behavior without targeting the behavior itself, which to me seems like something people would actually engage in.
|Voluntary Counseling and Testing|
Although I do feel that educating people about the biomedical model is one of the best options for HIV prevention, this statement cannot go unqualified. There is no proof that education will change behavior. Human behavior is not always rational; just because people learn about harms does not mean they are going to take the proper actions to prevent them. There are more complicated social problems that prevent rational behavior from occurring, such as gender inequalities, poverty, and sexual norms. The epidemic tends to gravitate towards circumstances where people’s choice is restricted, whether it be through gender roles or societal norms. Bombarding these people with behavior change messages just won’t work without first addressing the social problems, which is an enormous task with no easy solution.
Photos courtesy of CMT Norwood Open Day event