Report on the Global HIV/AIDS epidemic

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Prevention: daunting challenges ahead

Prevention: daunting challenges ahead

The spread of HIV relies primarily on private human behaviour. Even if individuals
everywhere had the full benefit of measures to reduce vulnerability and full access
to the tools and skills to prevent transmission, it is illusory to think that all the spread
would stop. However, two decades of experience show that behavioural prevention
can make a serious dent in the rate of new infections and change the course of the
epidemic. This section looks at progress and problems encountered in reducing the
spread of HIV through sex between men and women, through male-male sex,
through injecting drug use and through mother-to-child transmission.
A Avoiding heterosexual transmission: how well are existing
prevention strategies working?
The regional update (see pages 8-20) can leave no doubt: unprotected sex between
men and women continues to fuel the HIV epidemic in many countries, even in the
face of prevention campaigns. The situation is so serious that there is no room for
rhetoric or wishful thinking. It is time to take a long, hard look at what is working and
what is not.
A number of options are traditionally promoted in prevention campaigns directed at
the general public. One is to abstain altogether from sex - or, for young people who
have not yet become sexually active, to postpone the start of their sex life. Another
is to engage in sex that involves no penetration. As a further option, people are
encouraged to have sex with only one other person - someone who will never have
sex with anyone else. Mutual fidelity is protective, of course, only if both partners
stick to the rules and were uninfected to begin with. Finally, the consistent and correct use of condoms (both the traditional kind and the female condom - see page
63) for every act of sexual intercourse protects both partners from HIV and other
sexually transmitted infections.
These are not either/or choices. People may adopt different prevention strategies at
different points in their lives, and good prevention campaigns emphasize that many
options are available which reinforce each another.
There is now plenty of evidence about how well these various options work in prac55

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