Making Behavioral Science Mainstream in our Approach to HIV

A Village Savings and Loans Association meets in Aduku, Kwania District, Uganda as part of the DREAMS initiative aimed at reaching vulnerable adolescent girls and young women between 10-24 years old with access to a core package of HIV prevention and treatment services.

The beginning of this month marked 40 years of progress in the HIV response. The accomplishments over those years, including advancements in antiretroviral therapy and prevention strategies, have been significant. But challenges persist, particularly in addressing stigma, discrimination, and social inequalities associated with the disease and reaching communities that remain severely affected.

The journal Nature recently published an article by John Nkengasong, Mike Reid, and Ingrid T. Katz that acknowledges the complex interplay of social, cultural, and individual factors in the dynamics of the HIV epidemic. It advocates for an approach that integrates behavioral science into HIV intervention strategies. As the authors state, “Whether in relation to testing, antiretroviral therapy or PrEP and other prevention interventions, incorporating behavioural and social science into the design of health-care programs—and making this incorporation mainstream—will be essential.” The article is a poignant reminder that addressing the social and behavioral aspects of the HIV epidemic is critical to our collective response efforts.

Responding to stigma and discrimination. HIV-associated stigma and discrimination are significant barriers to prevention, testing, and treatment. It is imperative that we recognize and respond to the power dynamics, cultural nuances, and individual beliefs that influence behavior within communities affected by the virus.

A recent JSI webinar convened adolescent boys and young men in a discussion about the importance of their involvement in HIV interventions to address social norms that hinder access to health services and perpetuate gender-based violence. Behavioral and social approaches led by those directly affected by social norms are essential to understanding and shifting deeply ingrained beliefs and attitudes within communities.

Remaining culturally sensitive and contextually relevant. Behavioral science provides insights into the diverse cultural contexts, beliefs, and values that influence people’s decisions and actions. It allows us to work with HIV-affected communities to identify and adapt strategies that are appropriate for their culture and context, thereby enhancing effectiveness. As the Nature article points out, this can only be done if “ministries, clinicians, community health workers and HIV activists…participate in the design of programmes that ensure everyone has access to life-long HIV care that is centered around the needs of individuals.”

At the recent International Conference on AIDS and STIs in Africa, JSI hosted the satellite session, “Fostering adolescent and youth health resilience: Engaging diverse populations in HIV programming.” It featured a discussion with young people and their allies on what meaningful engagement really looks like, what enables and hinders a culture that promotes it, and opportunities to deepen this work to improve HIV and health outcomes for young people.

Affecting long-term behavior change. Change is not linear. Understanding the dynamics of behavior change is essential for designing interventions that resonate with individuals over the long term—a critical component in the HIV response. By helping us understand motivating factors, barriers to change, and social contexts, behavioral science principles can guide the development of interventions that are not only effective initially but are capable of fostering enduring behavior change.

As we move into 2024, let us resolve to make behavioral and social science a standard component of our public health toolkit. By embracing a behavioral science lens, we can foster more inclusive, culturally sensitive, and sustainable approaches that accelerate progress toward a world where HIV is no longer a public health threat.

By Adamson Ndhlovu, Melinda McKay, and Lauren Bader