Theoretical Approaches to Individual-Level Change in HIV Risk Behavior

Over the course of the human immunodeficiency virus (HIV) epidemic, large numbers of HIV prevention interventions have been implemented in a broad array of settings, but most have focused primarily —and in many cases solely—on providing information about HIV.

Abstract

Over the course of the human immunodeficiency virus (HIV) epidemic, large numbers of HIV prevention interventions have been implemented in a broad array of settings. Unfortunately, there typically has been an enormous gap between what is known about effective HIV prevention interventions and HIV prevention practice as typically implemented.1 To date, the vast majority of interventions targeting groups that practice high-risk behavior have been enacted by the public health sector and are government-funded projects. Generally, these are either implemented directly by state or provincial health departments, or funded by them and administered by community-based organizations (CBOs). All too often, neither behavioral scientists nor well-tested theories of behavior change are incorporated into the intervention design process,2,3 and rigorous evaluations of the efficacy of these programs are rare. A large number of additional HIV prevention interventions have been undertaken by the public schools,4 and in many jurisdictions there are laws mandating that HIV education be provided but without stipulations concerning how this should be done. Primary and secondary educational institutions generally have fielded extremely weak, atheoretical interventions designed not to offend the religious right wing, with content that is highly unlikely to effectively change HIV risk behavior.4 Until recently, of the entire "portfolio" of HIV prevention interventions that have been implemented, most have focused primarily —and in many cases solely—on providing information about HIV. Such information consistently has been shown to be unrelated to HIV risk behavior change.5–8