Applying social, behavioral and evaluation research to developing country HIV prevention programs
MacNeil, J.M.; Hogle, J.
Aids 12 Suppl. 2: S99-108
1998
ISSN/ISBN: 0269-9370 PMID: 9792367 Document Number: 279621
The campaign against HIV/AIDS has been hindered by a disjunction between behavioral research and the design of preventive interventions. A review was conducted of over 400 social, behavioral, and evaluation studies conducted as part of Family Health International's AIDS Control and Prevention Project in 45 countries in Latin America, Africa, and Asia in 1992-1997. Program-related research showed a shift from repetitive studies of knowledge, attitudes, and practice (KAP) to studies that yielded tangible information on how people change. Extensive use was made of findings from focus group discussions, key informant interviews, and baseline and follow-up KAP surveys to design culturally relevant interventions. Behavioral research evolved over time from a focus on traditional high-risk groups to broader populations such as adolescents and women. Most research continues to be descriptive, conducted in response to urgent program needs (e.g., for baseline data), and focused on individuals rather than social organizations. Valid assessment of the effectiveness of behavior change interventions presents numerous methodological and evaluation problems, including the bias inherent in self-report data, an inability to attribute behavioral changes to specific interventions, and the insensitivity of HIV prevalence as an indicator of short-term behavior change. However, the results of controlled intervention studies attest that prevention had had a substantial impact on HIV knowledge, attitudes toward those infected with HIV, perceptions of individual risk, and sex behavior among target groups. Continued triangulation of the results of a variety of sources and methodologies will reduce systemic bias in the research data.