The HIV/AIDS epidemic continues to spread rapidly in developing countries. Heterosexual transmission accounts for almost three-quarters of infections. Current strategies have been effective in the prevention of HIV spread within certain groups but they have had limited impact on the general spread of the epidemic. There is a need to complement these strategies with approaches that will influence the social and environmental determinants of risk to enable those vulnerable to infection to protect themselves.
PIP: Heterosexual intercourse is the mode of HIV transmission in 75% of HIV cases in developing countries. Mass awareness campaigns for the general public and interventions plus supportive services targeted at specific groups have been effective in prevention of the spread of HIV within these groups. These current interventions have not, however, brought about sustained behavior change or prevented the general spread of HIV/sexually transmitted diseases (STDs) in developing countries. Most prevention interventions focus on influencing individual behavior and do not take into account the social, economic, and structural determinants of risk that thwart adoption of risk reduction behaviors. The interventions promote reducing the number of sexual partners, using condoms, and controlling STDs. Some reasons they have failed to translate into effective prevention of the spread of HIV among the general public include: most monogamous women have partners who are not monogamous; non-monogamous women often have multiple sex partners to earn a living for themselves and their families; in some countries, condom use is thwarted by high cost, poor quality, limited availability, and no accessibility; condom use depends on the man's cooperation; there is a stigma attached to seeking STD services; and STD programs often focus on commercial sex workers and male clients. Current interventions do not meet the needs of the groups most vulnerable to HIV infection (e.g., women, youth, and single-gender migrant groups). Sexual health education, relevant health services, and supportive social and economic environments that will touch all vulnerable groups will reduce their vulnerability to HIV infection and strengthen their skills for protection. Leaders in developing countries need to move beyond their complacency and denial of AIDS and face the issues AIDS has forced society to confront.