20/10 - Behavior change - Vanessa Dang

Since I spent much of this past summer providing education and encouraging behavior change, I was excited to read this report on how effective it actually is. From the start, Gregson lists many of the reasons why some people believe that behavior change is not effective, or at least why we lack data that fully correlates a decline in HIV prevalence with behavior change. While I expected Gregson to provide sufficient evidence to override these claims, it seemed like he served more to support than to refute them. For example, after reporting the changes in behavior, Gregson finishes the article by discussing the impact of selective migration on HIV prevalence and then stating that ‘HIV prevalence reflects the accumulation of infections over a period of more than 10 years and is insensitive to behavior change.’ Based on these statements/reports, I didn’t feel fully convinced that the decline in HIV prevalence was due to behavior change.

At the same time, the 49% decline in HIV prevalence in women aged 15-24 years impressed me, however, it remains unconvincing that Gregson could use this drastic change with other statistics to indicate that behavior changes are the underlying reason for the decline. While I would have been more convinced if Gregson had refuted the various controversies behind the association of HIV prevalence decline with behavior change, I am still pleased with the report on the new, safer sexual practices in Zimbabwe. These changes really are impressive, especially considering a window of only 3 years, and are perhaps a good reason for continued education and behavior change/life skills education as a means of prevention.

Unrelated note: I was surprised to learn the reasons behind why HIV-infected men have a higher mortality rate than HIV-infected women. Gregson explains that men are generally older when they are first infected, due to engaging less often in risky sexual behaviors. I am curious what ages he is referring to, because it makes a difference in terms of how/why/when this change from safer to riskier behaviors occurs: when Gregson refers to ‘early-age,’ is he referring to teenagers who have not yet engaged in sexual activities, or is he referring to twenty year-olds who are practicing safe sex?