Marseille 2007
| Abstract #262 - New and emerging biomedical interventions to prevent the sexual transmission of HIV: social and behavioural dimensions | ||||
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Session: 29.2: Lessons learned for tomorrow's strategies (Parallel) on Tuesday @ 11.00-12.30 in Auditorium/Overflow Chaired by Lisa Power, Yves Souteyrand Authors: Presenting Author: Prof Graham Hart - University College London, United Kingdom |
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| Additional Authors: Dr John Imrie, Prof Jonathan Elford, | ||||
| Aim: Preventing the sexual transmission of HIV currently relies on a two-pronged approach which involves reducing partner numbers and using condoms for sexual intercourse. The continuing global spread of HIV, the presence of endemic infection in some communities, its arrival in new settings and re-emergence in communities where it was thought to be under control, have raised questions about current prevention paradigms. Internationally, there is impatience with low-tech and exclusively behaviour-based approaches in favour of new high-tech solutions that offer more promise. Indeed, one of the striking features of the 2006 International AIDS Conference held in Toronto was the extent to which technology for preventing the sexual transmission of HIV has developed. However, there is little evidence of an appreciation of the wider social and behavioural consequences of the introduction of these technologies, individually or in combination. | ||||
| Method / Issue: In this presentation we will review the range of new and emerging health technologies, including adult-male circumcision, microbicides, pre- and post-exposure prophylaxis for HIV, and early antiretroviral treatment (ART) for HIV infected individuals. We will then go on to argue that while bio-medical innovation needs to be embraced, we must also engage explicitly with a social and behavioural research agenda in relation to new prevention technologies. | ||||
| Results / Comments: Social scientific engagement needs to address both the expected as well as unintended outcomes and consequences of biomedical interventions, and to pay attention to issues of communication and social marketing. For example, for serodiscordant couples, primary and secondary prevention may converge in health promotion. For an HIV negative woman in sub-Saharan Africa, use of microbicides could offer a new approach to primary prevention. Secondary prevention might involve her HIV positive husband maintaining adherence to ART to achieve an undetectable viral load. But adherence to ART could also have implications for primary prevention since a low viral load may reduce his level of infectivity and so reduce further risk of transmission. It is possible to imagine other combinations of prevention opportunities according to which population group is under consideration; for example, MSM, sex workers and occupational groups with particularly high exposures. In this way, combined use of interventions of proven efficacy may achieve synergy and greater impact. But as well as identifying potential synergies we need to communicate the limitations of new technologies or their application. For example, to obtain the protection afforded by the invisible condom, men in some regions may turn to untrained practitioners for circumcision, which could lead to higher risk of HIV and other blood-borne infections. | ||||
| Discussion: Condom use has proved in many settings to be a highly effective means of preventing the transmission of HIV. However, the opportunities afforded by the introduction of new biomedical approaches to prevent the sexual transmission of HIV are most welcome. We are proposing that, alongside the development and adoption of new prevention technologies, there should be a systematic investigation of the major social and behavioural impacts that they could have. Social science research needs to be at the heart of intervention development, evaluation and roll-out. | ||||
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