The rapid spread of the Ebola virus through human-to-human contact — compelled by the urge to embrace a family member with symptoms of infection, to transport a neighbor to the nearest clinic, to nurse the infected or bury the dead despite the lack of basic protective gear — reminds us of the complex relationship between health and human behavior.
Like Ebola, HIV was once an emergent infectious disease. Although HIV may take years rather than days to kill its victims, similarities exist between HIV and Ebola in the conditions that facilitate their spread and the challenges to containing both diseases. Highly stigmatized, those who fear infection may avoid being tested or disclosing to loved ones; those diagnosed may face limited treatment options provided by harried health care workers within overburdened health care systems.
Now in its fourth decade, the fight against HIV has seen tremendous breakthroughs in medical technology. A spectrum of antiretroviral (ARV) treatment options now exists and is available around the globe. Clinical studies have proven that taking a daily oral ARV-based pill can reduce a healthy person’s chance of getting the infection — and, other types of ARV prevention products (i.e., gels, rings and injections) are on the horizon. Increased testing through provider-initiated strategies has increased access to both treatment and prevention technologies. There is even some thought that we will have a cure for HIV one day.
Still, our scientific approaches are often challenged by the day-to-day realities of those we hope to help. For example, within the treatment cascade, low levels of HIV testing and weak linkages to care create the greatest obstacles to containing the disease. Within the prevention realm, efforts to develop and test new products are undermined when trial participants do not take their study products as directed.
What we often forget — the heart of the matter — is that behaviors we hope to influence often take place within loving relationships. In Kenya, more than one-third (44%) of new infections occur within stable relationships. In southern Africa, young women describe using condoms with new partners until trust has been established. Women engaged in sex work may be driven to inherently risky behavior to care for their children. The desire to love — and to discount risk — cuts across gender, sexual orientations and geographies.
Public health efforts to develop and deliver new HIV treatment and prevention technologies have led to significant reductions in HIV incidence. But much remains to be done. As we commemorate this latest World AIDS Day, let’s keep the heart in mind.
Let’s figure out how to promote new HIV prevention technologies so they connote trust and intimacy, rather than distrust and deviance.
Let’s develop and implement our prevention and treatment strategies in ways that build on the relationships between sexual partners, families, communities and practitioners.
Let’s make sure that HIV prevention, care and treatment services are available for all people, especially the key populations most in need, such as young women, men who have sex with men, sex workers, people who inject drugs and transgender people.
As the public health community considers how to expand treatment programs, roll out new prevention products and link more people into HIV testing and care, we should remind ourselves about the role that otherwise positive emotions may play in increasing risk and bring both heart and mind to the fight.