Preventing and Mitigating AIDS in Sub-Saharan Africa Research and Data Priorities for the Social and Behavioral Sciences (1996) / Chapter Skim
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1 INTRODUCTION
1 INTRODUCTION
Pages 45-56
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From page 45... ...
Prevention efforts to date have included attempting to ensure a safe blood supply, launching massive public awareness campaigns about HIV and AIDS in an attempt to induce widespread behavior change, and instituting extensive marketing and distribution of condoms. There is encouraging evidence that behavior-change interventions can be effective.
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From page 46... ...
The purpose of this report is to consider the needs for research and data in the social and behavioral sciences that could help improve and extend existing successful programs and devise more effective strategies for preventing HIV transmission. We do so while recognizing that were such strategies to stop transmission tomorrow, a formidable burden of disease would remain because of the number of current infections.
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From page 47... ...
Because the costeffectiveness of prevention efforts declines rapidly as the epidemic spreads, the timing of interventions is crucial. Failure to control the epidemic now will mean that far more costly and difficult interventions will be necessary in the future (Potts et al., 1991; World Bank, 19939.
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From page 48... ...
The most optimistic reading of the results of these prevention efforts is that they have been less successful than was at first hoped. While targeted behavioral interventions are undoubtedly an essential part of prevention, it proved overly optimistic to believe that the first prevention messages some of which were hastily developed and quite generic-would induce widespread changes in sexual behavior.
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From page 49... ...
Many international donors do not want to commit themselves to providing care for the growing number of AIDS patients in countries where expenditures on health averaged less than US $15 per capita in 1990. The most visible consequence of donor fatigue in Africa is the withdrawal of resident WHO/GPA advisers from national AIDS control programs.
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From page 50... ...
One way to quantify the impact of AIDS in Africa is to calculate the number of "discounted healthy life years" that would be gained by averting a single new case of HIV. The benefits of averting a case 19.5 discounted healthy life years are very high relative to other diseases; by this measure, HIV ranks lower than neonatal tetanus, but higher than other widespread illnesses such as malaria, tuberculosis, and measles.
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From page 51... ...
Effective prevention of the disease requires enormous and continued commitment in order to achieve lasting changes in human behavior. No one set of interventions behavioral or medical will be sufficient by itself to combat the HIV/AIDS epidemic.
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From page 52... ...
The goal of the Panel on Data and Research Priorities for Arresting AIDS in Sub-Saharan Africa was to identify and describe the numerous behavioral and social factors that affect the spread of the HIV/AIDS epidemic in Africa, to identify or clarify strategic opportunities for donors and African governments to develop effective interventions both for preventing the spread of the epidemic and for mitigating its impacts, and to elucidate the most pressing research requirements over the next 5 to 7 years for facilitating the development of more effective prevention and control strategies in the future. At the outset, the panel realized that this mandate was nearly impossible: the strategies and issues surrounding the HIV/AIDS epidemic are extremely complex and change constantly as the epidemic evolves.
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From page 53... ...
We hope this report will serve as a useful starting point for future participatory discussions among researchers from both developed and developing countries. ORGANIZATION OF THE REPORT This report offers recommendations in five critical areas: monitoring of the overall status and context of the HIV/AIDS epidemic in Africa, gathering of information on sexual behaviors associated with the spread of the epidemic, primary HIV-prevention strategies, strategies for mitigating the impact of the epidemic, and the need for building an indigenous capacity for AIDS-related research in Africa.
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From page 54... ...
Basic principles of successful intervention programs include adapting the program to local conditions, carefully targeting the audience, building local capacity, ensuring community participation, evaluating results, and using the results from evaluation studies to improve the program. Successful intervention programs should also be multidisciplinary and multifaceted and involve multiple contacts with targeted populations.
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From page 55... ...
Beyond the immediate challenge of the panel's mandate identifying the critical research priorities there remain enormous practical challenges surrounding the implementation of those priorities. The final chapter examines the enormous constraints to conducting research in sub-Saharan Africa and proposes means of alleviating some of these problems, including establishing a sub-Saharan Africa AIDS research institute with a strong behavioral and social science component.
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From page 56... ...
An effective partnership between research and program interventions will be key to lessening the spread and impact of the HIV/ AIDS epidemic in sub-Saharan Africa.
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