2010-May-26, Public health and HIV/AIDS prevention policies should reflect and work with evolution of sexual behavior

HIV/Aids prevention campaigns which take into account changing sexual trends and social norms are more effective than campaigns which ignore them, according to the results of a series of surveys conducted in France. The findings will be published in the forthcoming issue of AIDS (http://www.aidsonline.com), the leading journal in the field of HIV and AIDS research. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

The study, headed by Dr Nathalie Bajos from the Institut National de la Sante et de la Recherche Medicale (INSERM) in Paris, outlines the changes in sexual behavior and norms as revealed by a series of three random probability surveys conducted in 1970, 1992 and 2006. Bajos and her team report that over the last few decades, the average age at first intercourse has decreased by 4 years for women, from 22.0 years in the 1930s to 17.6 years in the 2000s, and one year for men, from 18.1 years to 17.2 years. The average number of sexual partners a women has during her lifetime has more than doubled since the 1970s, from 1.8 to 4.4 in 2006, while the average for men has remained largely unchanged, from 11.8 to 11.6. At the same time, the proportion of respondents, especially women, who reported nonpenetrative sexual practices and considered sexual intercourse essential to well being was on the increase.

The investigators attribute these changes to an increase in women's social status during the 20th century. They have also observed a marked increase in condom use following the first HIV/Aids prevention campaigns in the 1980s in France and elsewhere around the world, where prevention policies aimed at harm limitation, rather than abstinence, appear to have chimed with secular trends. Bajos and her team conclude that public health interventions which are synergistic with changing trends in social norms are likely to be more effective than those which run counter to them.

In a commentary which accompanies the publication of Bajos and her co-authors' findings, Michel Caraël and John Cleland point out that the "debate about sexual behavioral change and HIV is often narrowed into considerations of A,B,C (abstinence, be faithful, and condom use) or concurrent versus serial sexual partnerships. Such reductionist approaches give rise to conventional recommendations on HIV prevention 'messages' addressed to individuals, with the naïve belief that they will lead to important behavioral changes at the population level." They praise the study by Bajos for reminding us "how much the evolution of sexual behavior, far from being a health-related behavior, is determined by changes in nuptiality and broader social structural factors." Public health and HIV/Aids prevention policies should reflect and work with these changes, rather than against them, if they hope to be effective.

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