Strategic Roles for Health Communication in Combination HIV Prevention and Care Programs

This JAIDS: Journal of Acquired Immune Deficiency Syndromes supplement addresses clinicians and public health scientists in the field of HIV prevention and treatment who might value information on health communication. It "seeks to broaden this discussion across disciplines so as to maximize the combined impact, particularly in low- and middle-income countries, of health communication, other behavioral approaches, and biomedical approaches to HIV prevention and care.... Thus, this supplement illuminates key issues relating to how strategic communication has best been used to improve HIV prevention and care outcomes, how its impact can be measured, and how it can be better integrated in future HIV programs in low- and middle-income countries." (Footnotes are removed by the editor.)

This introductory article for the supplement discusses the fact that prevention and treatment behaviours, for example, condom use and pre-exposure prophylaxis, require health-related decisionmaking outside of clinical settings. Other behaviours may include lifetime treatment adherence, use of clean needles and syringes, male circumcisions, HIV testing, and antiretroviral prophylaxis, especially for HIV-positive pregnant women, mothers, and infants. Risk reduction also requires behaviour change, including "limiting the number of sexual partners and engaging in lower risk sexual behaviors".  As stated in the article, effective health communication, especially directed toward behaviour change outside of controlled settings, is necessary for the success of biomedical HIV interventions.

"Health communication takes place at the individual level (eg, counseling), through family- or community-based interventions, at the community level, within service delivery, or at a population level, often through the mass media and, increasingly, via mHealth, using mobile devices, such as cell phones, smart phones, and the Internet. Furthermore, health communication may address the behavior of the individual, or it may seek to change the environment and structure that influences and sometimes even determines individual behavior. All may be woven into a fabric of outreach styles and approaches. All are within the bailiwick of health communication professionals. The articles in this supplement address these considerations."

The issue overview describes the supplement contents (available here):

What Is Health Communication and How Does It Affect the HIV/AIDS Continuum of Care? A Brief Primer and Case Study From New York City

Health Behavior Change Models for HIV Prevention and AIDS Care: Practical Recommendations for a Multi-Level Approach

Effects of Behavioral Intervention Content on HIV Prevention Outcomes: A Meta-Review of Meta-Analyses
   
Strengthening Nonrandomized Studies of Health Communication Strategies for HIV Prevention
   
HIV Communication Programs, Condom Use at Sexual Debut, and HIV Infections Averted in South Africa, 2005
   
Validity of Behavioral Measures as Proxies for HIV-Related Outcomes
   
Enhancing Reporting of Behavior Change Intervention Evaluations
   
HIV Communication Capacity Strengthening: A Critical Review
   
A Role for Health Communication in the Continuum of HIV Care, Treatment, and Prevention
   
Role of Community-Level Factors Across the Treatment Cascade: A Critical Review   
   
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
       
Effectiveness of Mass Media Interventions for HIV Prevention, 1986-2013: A Meta-analysis

The conclusions include areas for further research including:

• "...how health communication can be used most strategically in prevention efforts and to work across disciplines to broaden our thinking and challenge our assumptions."
• "... how communication can enhance critical preventive behavioral pathways and support biomedical interventions will help illuminate the most promising and effective strategies, given local sociocultural environments."
• how can program managers and policy makers "better understand the cost, cost-effectiveness, and return on investment of such interventions."

The conclusions also suggest a need for continuing evidence "on the continuum of care that is being rolled out in 'treatment as prevention' initiatives, preexposure prophylaxis, voluntary medical male circumcision, and combination prevention initiatives.  Integration of behavioral approaches facilitated by health communication into these biomedical approaches will determine the degree, and speed, of their success. The true test of all HIV prevention and treatment efforts is whether, working in concert, they reduce HIV incidence, transmission rates, and deaths."