KHOPOTSO: The only certain way to reduce HIV infection rates is through prevention. But no HIV vaccine is showing promise. Research into vaginal gels called microbicides, have also not found a protective get yet, although results of the Carraguard microbicide will be announced next month. But even if Carraguard works to protect women against HIV, researchers say it won’€™t offer full protection. Studies into male medical circumcision have shown that it can reduce chances of men acquiring HIV from women by up to 60%. But without the use of condoms – the only proven protective measure available to us at the moment – that could spell danger. So, how best can we protect ourselves against HIV?

PREMIER MBHAZIMA SHILOWA: If we’€™re going to really turn the tide’€¦ one of the things we’€™ve got to do is to look at what are we going to do to ensure that all of us change our behaviour’€¦ We decide individually ‘€“ I’€™m aware and I intend to change my behaviour. It means if you’€™re negative, you will try and ensure that you stay negative; that if you’€™re positive, you will try and ensure that you don’€™t infect someone else; that if you’€™re positive, you will try and ensure that you do nothing that will ensure re-infection.

KHOPOTSO: Gauteng Premier Mbhazima Shilowa, speaking recently at the provincial government’€™s AIDS conference. He said it’€™s important for people to examine some of their behaviours and how they influence their actions.      

PREMIER MBHAZIMA SHILOWA: Behaviour change also includes, by the way, our own lifestyles’€¦ Some of us go out, really drink beyond what we should do, we take drugs, and thereafter, we are happy, we are amorous, we are friendly, we’€™re now more than generous with ourselves ‘€“ and I’€™m talking both men and women’€¦ We need to be able to understand that it is those kinds of things that we need to think about.

KHOPOTSO: Put another way, says Shilowa, behaviour change is the power that many people have to individually safeguard against HIV infection, but fail to use.

PREMIER MBHAZIMA SHILOWA: What is important is to keep remembering that the decisions we take as individuals will ultimately determine whether we achieve the goal of an HIV-free generation. When all the information has been provided it is an individual’€™s decision not to have sex, to be loyal to one partner or to use a condom. These are decisions that each and every one of us has to make. Sure, there is peer pressure’€¦ but in the end it’€™s your decision.            

KHOPOTSO: With efforts from the scientific arena to develop interventions to prevent HIV infections drawing a blank, scientists and researchers also agree that behaviour change is probably the best form of prevention available to stop increasing HIV rates. Professor Lynn Morris of the National Institute for Communicable Diseases, in Johannesburg, is heavily involved in HIV vaccines research in South Africa. Recently, a study called Phambili had to be abandoned after interim results from a sister trial in the United States showed that the vaccine does not offer any protection.

Prof. LYNN MORRIS: As you know many of the preventative things that we’€™re trying ‘€“ the microbicides are not proving very effective, obviously, this vaccine trial is extremely disappointing, the diaphragm study showed no effect ‘€“ so, really, from a public health point of view we’€™re finding it very difficult, actually, to intervene and stop the spread of this virus. Of course, there are other ways that people can protect themselves ‘€“ obviously, behaviour change and condoms ‘€“ and that’€™s what we’€™ve got to really press home to people, that they need to be adopting those kinds of practices because, I think, it’€™s going to be a long time before we have a vaccine.            

KHOPOTSO: On the microbicide research front, results of the only product to have completed all research processes are expected early next year. Dr Khatidja Ahmed is the Principal Investigator in the Carraguard trial.    

Dr KHATIDJA AHMED: We’€™re looking at prevention being better than cure. So, a lot of emphasis has been placed on prevention methods, as you correctly say. We have behavioural changes, which, of course, is the most important part of it all.  

KHOPOTSO: Condoms are the only method to prevent HIV infection for those who are sexually active. But they have to be used consistently and with care. They form part of the universal ABC strategy of prevention, which focuses on behavioural change. But behavioural change goes much further than simply abstaining from sex, being faithful to one partner and using condoms. Some would also argue that the ABC strategy is too simplistic for certain groups of society, such as women who cannot always negotiate safe sex. Perhaps it’€™s time for a national dialogue on behavioural changes and HIV prevention, just like there has been on AIDS treatment.