Changing behaviors and societal norms is difficult work. There are no magic solutions. Implementing an effective behavior change program is complicated, resource-intensive and time-consuming. To achieve reductions in new HIV infections, prevention programs must affect change in the most private and most fundamental of human behaviors, sex. This can never be done solely by providing basic knowledge about the causes and consequences of HIV and AIDS.
Rather, prevention efforts must deal with individual health behavior-including sex in its social and cultural contexts. National prevention strategies need to ensure universal access to tools that enable individuals to protect themselves from infection. Such tools can include condoms, voluntary counseling and testing, prevention of mother to child transmission of HIV (PMTCT) services, effective blood screening and blood safety programs, and proper management of STIs as well as factual, frank knowledge about how people can reduce the risk of HIV transmission. Behaviour change should focus not only on abstinence, reduction in the number of sexual partners, and condom promotion, but also on economic and social practices that put people at greater risk of HIV infection, such as poverty, gender inequality, cultural myths about sex, sexual coercion, and stigma. Prevention efforts should focus on helping people develop skills and motivation needed for behavior change. Educational programmes should involve interactive features that are more powerful than information alone. They should be participatory, using explicit approaches- such as role playing e.g. on how to negotiate condom use with partner, as these will be more likely to effect change. Programs must help alter individual beheviours by addressing broader gender based barriers to change and by developing support systems for change.
Health Behavior change experts advocate using a "social ecological" model as an approach to behavior change that posits that interventions are more likely to success if they simultaneously target multiple levels of influence on health behaviors. This model advocates thinking about five levels that can be targeted toward promoting change:
- Intrapersonal (or individual).
- Community, and
In designing HIV and AIDS prevention programmes, interventions that can influence two or more "social ecological" levels at the same time can often create a synergistic effect, in which the whole is greater than the sum of the parts.