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Preventing HIV and AIDS takes Behavioral Research

There's more to HIV/AIDS prevention than instructions in condom use, behavioral researchers note. A team outlines next steps in confronting complex health-related behaviors.

Researchers studied the available information on behavioral changes and preventing human immunodeficiency virus (HIV) spread and found that one size does not fit all.

A paper, authored by Michelle Kaufman, PhD, of Johns Hopkins University Bloomberg School of Public Health, Center for Communication Programs in Baltimore, MD, and colleagues, describing the research, was published in the Journal of Acquired Immune Deficiency Syndromes recently.


The researchers begin with the idea that slowing the worldwide spread of HIV “is not simply about using condoms or adherence to medication.”

Instead, they say, a multi-level approach that takes numerous factors from power dynamics between partners to public policy into account is necessary. However, they say, “evidence addressing a more holistic approach to changing HIV-related behaviors is limited.”


They suggest there are three big reasons for the dearth of research into multi-level approaches: it is difficult to measure the impact without encountering great expense or difficulty; such interventions are complex, not specific, and diverse, making them difficult to replicate; random controlled trials, which are considered the gold-standard in research, are simply not feasible or appropriate for multi-level behavior change interventions.


“This article,” say the authors, “aims to contribute to the shift to a more holistic approach by synthesizing and making sense of a complex literature, leading us to outline the next steps required as clearly as possible.”

They go on to list four goals: to list the relevant factors that are important to change behaviors, at all levels; to identify and compare the characteristics of multi-level models that have be implemented; list the challenges in using such models; and to outline recommendations for next steps.


The authors say their research “suggests several ways researchers and practitioners can advance in understanding behavior related to HIV prevention and care and incorporate these multi-level approaches into behavior change interventions.”

Some of the implications include considering all of the levels which contribute to the process of changing behavior, collaborating with professionals in other disciplines to identify variables, choosing just a few levels at which to measure and test in an intervention, and analyze the relationships between and within levels.


The authors conclude, “We are beginning to make progress in broadening our behavior change theories and models,” and add, “Much stands to be gained in improving HIV prevention and care if we consider more comprehensive models of behavior change.”

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