Key Interventions and Strategies

Condom social marketing (CSM)

Condom social marketing (CSM) involves efforts to make male and female condoms more affordable, attractive, and accessible through culturally specific marketing techniques. Many CSM efforts include media messages designed to influence sexual behavior or brand preference. Social-marketing condoms are often specially packaged and sold at a lower price than commercial brands.

Behavior change communication (BCC)

Behavior change communication involves efforts to assist individuals to change high-risk behaviors and to educate communities to support long-term change. BCC can involve a variety of intervention types, including:

• Mass media and small media
• Interpersonal communication/counseling—individual, small group, couple, or family
• Peer education/counseling

Voluntary HIV counseling and testing

There has been debate concerning the effectiveness of voluntary counseling and testing (VCT) as a strategy for HIV prevention. In theory, if a person tests negative, an opportunity exists to counsel him or her about primary prevention (how he or she can remain uninfected). If a person tests positive, an opportunity exists for secondary prevention (how he or she can prevent transmission to others). The relationship between knowledge of HIV status and changes in risk behaviors—in particular decreases in such behaviors by people who know they are infected with HIV—is unclear. Study results vary, with some finding significant decreases in risk behaviors in those who knew they were HIV-positive, and others not. While it is clear that some individuals do reduce risks after knowledge of a positive HIV test, it is also clear that others do not. Similar results have been seen in people who tested negative. Ongoing counseling and testing (in other words, repeatedly over time) appears to have a greater impact on reduction of risk behaviors than one-time counseling and testing.

Access to affordable treatment is an important ethical and programmatic concern that must be taken into account when testing services are established. Testing is now being actively encouraged in the developed world, where effective medications for the treatment of HIV and opportunistic infections are more readily available and early treatment is often feasible.

In developing countries, despite lower levels of access to treatment, VCT is receiving increasing support since it can be an important entry point for accessing care as well as prevention. On the community level, when prevention and care are offered together as a part of a “prevention-to-care continuum,” they work synergistically. They improve community acceptance, reduce the stigma of HIV/AIDS, and encourage HIV-infected people to practice preventive behaviors and seek care and support.

VCT is also recognized as an essential component of care for pregnant women in order to determine options for prevention of mother-to-child transmission (MTCT).

Community interventions

Although the term “community interventions” can include many different types of approaches, interventions that seek to shift social norms or mobilize communities for action are recognized as key strategies in confronting the HIV epidemic. For example, such efforts might include reaching out to individuals in their homes or gathering places with information and education; organizing community educational events (through, for example, theater or sporting events); working with religious organizations and leaders, as well as with traditional healers; working with young people in schools, as well as with out-of-school youth; or integrating STI/HIV prevention education into existing community-health-outreach and community-based contraceptive-distribution programs. The aim of outreach efforts in these various settings is to combat stigma and discrimination associated with HIV/AIDS, educate community members how to protect themselves from infection, organize care and support for those who are ill or otherwise affected, and provide care for children orphaned by AIDS.

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