The response to HIV has for decades engaged in the debate and interplay between prevention and treatment. It is particularly in the prevention in the response to HIV that the topic of behavior change has been highlighted. The language that has been used in this regard has in itself been very stigmatizing. “If only we can get men to get their flies up.”
“If only we can get men to use condoms.”
“If we can only…”
The reality is that behavior change is probably the most complex and difficult challenge that we face. And a very good example of this is the lack of behavior change that we see in societal attitudes. Perhaps our “if only’s” could be phrased a different way.
If we could only stop seeing men as the protagonists of HIV transmission.
If we could only stop seeing gays as sexually perverse.
If we could only see people living with HIV as people first.
If we could only…
This in itself should show us how difficult behavior change is. A major inhibiting factor remains that we see behavior change as an individual rather than a societal necessity. Understanding how difficult behavior change is, gives us an easy entry point into an entirely different approach. And that is the approach of behavior formation. We know that habits can be formed very easily. When it comes to HIV prevention, it is particularly habits related to sexual practice that we need to see formed as early as possible in life.
Well developed, comprehensive and age appropriate sex and sexual reproductive health education and services would pay excellent dividends in assisting in behavioral formation.
When I recently visited China, I found that sexual transmission of HIV was a relatively low risk factor among heterosexual couples and the simple reason for this was that the China’s “one child policy” has demanded that people use contraceptives. So the topic of condom usage is not at all an issue when it comes to heterosexual sex. The most remote villages made condom dispensing machines freely available on the outside of clinics.
But the need for the prevention of unwanted pregnancies is not a factor of same sex sexual relations. Consequently distributing and getting gay men to use condoms is both stigmatizing and challenging. This effectively shows that behavior formation requires behavioral or attitudinal change within societies, not just individual practice.
As we strive to reach the UNAIDS targets in zero new HIV infections, we will need to think outside the box. Expand our horizons, challenge our preconceived ideas.
In countries like the Philippines, with the runaway figures around HIV transmissions, an entire cultural shift is needed. Not only in terms of prevention but in awareness of risk in relation to HIV. Behavioral formation related to gay men is not possible if you can’t speak about it to children in schools. Behavioral formation about condom usage is not possible if you only address condom usage after adolescence after they have become sexually active. Behavioral change in a culture of knowing your status is not possible until the vulnerability of every person in relation to HIV is acknowledged. And behavioral change is not possible until the stigma that associates HIV to promiscuous sex or drug use is comprehensively eradicated.
Behavioral formation is the way to go.
Let’s start by forming new understandings about our own vulnerabilities to HIV, and the appropriate responses needed in terms of prevention, treatment, care, and support.