It is important that people already infected with HIV help prevent the spread of the infection through such practices as safer sex and safer drug use. Not only do infected people run the risk for infecting others, but they are also at risk for contracting other, and possibly more virulent, strains of the virus, as well as other illnesses which are transmitted sexually (i.e., syphilis) or through shared drug equipment (i.e., hepatitis B and C).

Because no cure for HIV/AIDS is available, the only way to prevent HIV infection is to avoid behaviors that put a person at risk. Many people infected with HIV have no symptoms, and, therefore, there is no way of knowing with certainty whether a sexual partner is not infected unless he or she has repeatedly tested negative for the virus—and has not engaged in any risky behavior between tests.

Behavior Change

A variety of related and overlapping behavior change theories and paradigms have been used to inform the development of prevention programs and interventions. In general, these theories and paradigms recognize the complexity of human behavior and the myriad psychological, sociocultural, and structural factors that play a role. More recently, increased attention has been given to the idea of looking beyond individual behaviors to the contextual factors (conditions) that make people vulnerable to STI/HIV infection and that influence behavior. These include, for example, social norms, gender inequalities, and poverty.

In STI/HIV prevention, as in other areas of health and behavior, the knowledge-attitude-behavior (KAB) or knowledge-attitude-practice (KAP) continuum is often referred to. It is simply a convenient way to organize the many aspects of knowledge and attitudes that must be present before changes in behavior or practices can occur.

Sexual behavior, however, is not easy to change. Simply telling clients that certain behaviors put them at risk for STIs or HIV is generally insufficient. For example, a person must know which practices can put an individual at risk (knowledge), must believe that “people like him or her” can be at risk (attitude), and must believe that he or she is at risk (attitude) before that person can take action to change his or her own behavior (practice). Interventions must be in place to address all three levels, and people must know what to do to protect themselves, must feel that they have the ability to effect change, and must have the skills and resources to do so. Most important, people must have willing partners and a supportive environment.

“Stages of change” model

A variety of theoretical models examine the factors that contribute to behavior change. One such model is the “stages of change” model.

This model suggests that individuals or groups pass through six stages when changing behavior: pre-contemplation, contemplation, preparation, action, maintenance, and relapse. For example, when people change their behavior by using condoms to protect themselves from infection, the stages they pass through could be described as:

1. Pre-contemplation: Have not considered that they are at risk and need to use condoms
2. Contemplation: Become aware of their risk and subsequent need to use condoms 
3. Preparation: Begin to think about using condoms in the next months
4. Action: Use condoms consistently for fewer than six months
5. Maintenance: Use condoms consistently for six months or more
6. Relapse: May begin to use condoms less consistently or discontinue use

These stages are not linear; people tend to move back and forth fluidly between stages, and relapse to a prior stage is always possible. In fact, people can relapse to any stage, but a return to pre-contemplation is least likely. It is important to remember that changing behaviors, especially intimate and private behaviors, is a complex process.

Adapted from UCSF AIDS Health Project, 1998, Building quality HIV prevention counseling skills: The Basic I training.

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