The best HIV prevention programmes use a combination of ‘persuasion’ and ‘enablement’.

Persuasion means giving people accurate information and motivating them to protect their health. This includes encouraging people who are at low risk from HIV not to change their behaviour.

Enablement means making it easier for people to put knowledge about protecting their health into practice. It includes making condoms easily available and making health services accessible and supportive. It means changing laws and policies, so that people at risk, such as young people, sex workers and injecting drug users can be easier to reach.

Successful strategies
A review of HIV prevention programmes worldwide slows that the most successful programmes:

Involve the community

Build partnership and trust between people.

Involve people with HIV in all stages.

Develop the skills and knowledge of the community

Create an open and accepting environment

Involve other sectors as well as health (multisectorial)

Win support from people in power

Are carefully planned and evaluated

Recognise that even well planned approaches sometimes fail

Successful programmes have several components, which together make up a good prevention package:

Information about HIV transmission activities to encourage people to assess risky behaviours,

Training in communicating about sex and drug related issues

Access to resources such as condoms and appropriate health services.

People’s concern

Since HIV prevention is rarely a person’s only concern, it is important to: ­

Begin with people’s own interests and needs

Involve people in the design and implementation of the project

Recognise the realities that people face in their daily lives

Focus on the sexual health of men as well as women

Examine the positive aspect of sexual health, including pleasure and enjoyments, as well as problems such as unwanted pregnancy and sexually transmitted infections.

Link sexual health to people’s broader concerns.

Adults often target young people with HIV prevention messages. It is especially important to begin with their interest, encourage their participation, and link HIV issues into broader concerns, such as relationships, families and plans for the future.

Injecting drugs users

Injecting drugs users are risk of HIV from both sex and sharing injecting equipment HIV prevention strategies also include:

Stopping injecting drugs, which may mean switching to non-injected drugs (this is a safer option)

Using sterile needles and syringes, and not sharing them (safe if done every time)

Cleaning equipment between use (safe but difficult to do properly). There is evidence that drug injectors can and will change their behaviour to reduce HIV-related risks.

Sex workers and men who have sex with other men

Sex work and sex between men is highly stigmatised and illegal in some countries. For these reasons, these groups can be difficult to reach. The best way may be through community-based outreach workers or peer educator.

Essential evaluation

Evaluation is essential to the success of HIV prevention programme. Evaluation can provide useful feedback for developing the project. Many projects are not evaluated because of pressure on time and resources.

However, evaluation need not be expensive or time consuming if the aim and activities of the project are properly thought out and written down before the project begins.

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