When biomedical answers have supplanted behavior change messages as the most promising measures of preventing HIV transmission, what is the role of health communication in confronting the epidemic now?
That is one of the questions an interdisciplinary group met to discuss at the Johns Hopkins Bloomberg School of Public Health last year and it led to the just released Journal of Acquired Immune Deficiency Syndromes special issue focused on Health Communication Strategies in Combination HIV Prevention and Care Programs. The 13 peer-reviewed articles the supplement contains are available free online and examine the role of health communication in addressing individual, community, and structural barriers to risk reduction, testing, linkage to care, adherence to treatment, and, yes, even effective behavior change messaging.
The role of health communication is more essential than ever, panelists agreed this morning, at an event launching the supplement at the National Press Club. They presented findings from three of the articles, on the effects of behavior interventions on HIV prevention outcomes, on the role of community factors in HIV awareness and care, from testing to adherence to treatment, and on improving or detracting from efforts to reach men who have sex with men, people involved in sex work, people who inject drugs, and transgender people. Their comments were linked by a common reiteration, that knowledge and community support increase the chances of healthy behaviors, from awareness of HIV infection, to motivation and ability to overcome obstacles to antiretroviral treatment adherence.
“You don’t have to hit people over the head to get behavior change,” Blair Johnson, a professor of psychology at the University of Connecticut at Storrs said. He presented findings from a Meta-Review of Meta-Analyses of the effects of behavior intervention on HIV prevention outcomes. While efforts to change sexual behavior are among the least successful, the review found, many interventions are effective. That includes instruction on condom use for adolescents, which did not increase the odds those teenagers would be sexually active, Johnson noted, “instead it had the opposite effect.”
In turn, communities in Zambia that showed high levels of support for people living with HIV increase the odds that people get tested for HIV and return to receive the result, Carol Underwood of Johns Hopkins University Bloomberg School of Public Health said, highlighting findings from her review, Role of Community-Level Factors Across the Treatment Cascade.
Increasing the odds of HIV prevalence among men who have sex with men, research in Uganda showed, was exposure to homophobic abuse, Claire Holland of the Key Populations Program, at Johns Hopkins Bloomberg School of Public Health pointed out. Presenting findings from Enhancing Benefits or Increasing Harms: Community Responses for HIV among Men Who Have Sex with Men, Transgender Women, Female Sex Workers, and People Who Inject Drugs, she also noted that among people who inject drugs in Thailand, ever having been refused health services was highly associated with never getting tested for HIV.
All, whether on a community level, an individual level, or as Underwood noted, where community and individual meet, at a structural level, can be made better or worse through communication, the panelists agreed.
“Behavior is never going to go away,” Johnson said. “Behavior is life.”