Marseille 2007
| Abstract #321 - The Effectiveness of Bio-Medical Prevention Relies on Behaviour Change | ||||
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Session: 29.1: 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 Susan Kippax - The University of New South Wales, Australia |
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| Additional Authors: | ||||
| Aim: Issue: This paper takes up the issue of what is bio-medical prevention. It raises a number of issues in relation to: (1) the term itself most prevention methods are bio-medical or at least rely on technologies (2) the nature of trials evaluating efficacy and effectiveness (3) the downplaying of the social and cultural aspects | ||||
| Method / Issue: Discussion | ||||
| Results / Comments: Not based on empirical data. | ||||
| Discussion: Project: Prevention methods that do not involve some form of technology are few, e.g. abstinence and monogamy. Most prevention interventions involve adoption of some sort of bio-medical intervention or technology, and effective prevention involves the sustained use of these technologies. The social and the cultural aspects are as important as the biomedical aspects of prevention. Whatever the technology of prevention condoms, microbicides, circumcision, vaccines, pre-exposure prophylaxis they need to be shown to be safe, efficacious and effective. While it is comparatively straightforward to prove safety and efficacy, it is far more complex to show that any given prevention method is effective, that is, will be taken up in a manner that will guarantee lowered rates of HIV transmission in populations at risk of HIV. Effectiveness depends and relies on behavioural change because, broadly stated, nearly every bio-medical intervention has one or more associated behavioural components than can (and will) influence its success or failure. Without behaviour change, there is no adoption and no sustained use of the technology. For each prevention technology, we need to know, with respect to both the personal and the social or socio-cultural: Whether the technology is acceptable? Whether it is likely to be taken up/ adopted? Whether it is sustainable? I argue that the recent bio-technologising or bio-medical move, while central to the fight against HIV and AIDS, can not lead to a down-playing of the role of social and cultural factors in the prevention of HIV. Rather such a move highlights their centrality. This is especially true in the case of some of the newer technologies, which may undermine or disinhibit the use of some of the older technologies, for example, condoms, rather than complement them. Summary: It is essential that when biomedical or new technologies are trialed, the social and cultural aspects of their acceptance, up-take and sustained use are investigated at the same time and the impact of their uptake on other prevention technologies or methods are assessed. HIV is a pandemic is driven primarily by behaviour patterns, patterns produced by social and cultural norms and expectations, and prevention technologies will be effective only in as much as we address and understand the human and socio-cultural aspects as well as the technological ones. Prevention interventions need to be cognisant of the wider social and economic contexts in which they are introduced otherwise it is unlikely that they will make much of a dent in the current annual rate new infections. As a first step, efficacy and effectiveness trials of biomedical prevention technologies must build in strong social research studies and fund them appropriately. | ||||
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