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Student Editorials

Why HIV prevention programmes fail

BMJ 2003; 327 doi: https://doi.org/10.1136/sbmj.0312439 (Published 01 December 2003) Cite this as: BMJ 2003;327:0312439
  1. Catherine Campbell, Reader social psychology1
  1. 1London School of Economics, and HIVAN, University of Natal, South Africa

Catherine Campbell explains the reasons behind this, which may also apply to other programmes

Why do many well intentioned HIV prevention programmes have disappointing results? How do the beliefs and practices of medical doctors and researchers contribute to the success or failure of prevention efforts? In seeking to explain the obstacles to effective management of HIV and AIDS, attention is usually given to factors internal to affected communities (such as exotic aspects of local cultures; or individuals' health, attitudes, or behaviours). The spotlight also often falls on technical aspects of control regimens for sexually transmitted infections (STIs) or the content of health educational messages. Less attention has been given to the way in which prevention efforts are conceptualised and managed, and to the challenges that face those trying to build partnerships between medical doctors and researchers and the non-traditional partners they need to work with if the epidemic is to be effectively managed in the marginalised communities in which it often flourishes.

Good intentions

CRISPIN HUGHES/PANOS PICTURES

Backing for HIV prevention

These factors are showcased in a case study of a state of the art prevention programme in a South African mining community.1 This programme was well funded and backed by an impressive array of local and international experts. On paper it seemed ideal. It was initiated by a group of township residents concerned about rocketing levels of HIV (baseline research showed that levels of HIV were 22% among mineworkers, 68% among sex workers, and 50% among young people). The programme was managed by a representative group of “stakeholders” living or working in the local community-grassroots groupings, mining industry doctors and human resources personnel, private GPs, traditional healers, trade unionists, representatives of local and national health departments, biomedical and social scientists, and foreign donor agencies.

GIACOMO PIROZZI/PANOS PICTURES

A peer educator …

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