AIDS: is health education the answer?

In the absence of a vaccine or effective treatment, prevention of infection with the human immunodeficiency virus (HIV) is presently the only feasible option for the control of AIDS. Most transmission is related to high risk behaviours, and attempts to change these behaviours are key objectives of many AIDS Control Programmes. Health Education, or Information, Education and Communication (IEC) strategies have been developed to achieve these objectives. Yet few evaluations of health education programmes have been carried out, and the intimate relationship between AIDS and other sexually transmitted diseases is often ignored. Behaviour has a multitude of determinants, and consequently no simple approach focusing on one aspect of behaviour can be expected to be successful. Not only does knowledge need to be imparted, but attitudes, beliefs, social- and peer-group norms need to be addressed. The development of IEC programmes is hampered by the specific routes of transmission of the HIV, involving sensitive areas of human behaviour, and by a lack of knowledge about these behaviours. Nevertheless, a number of seemingly successful programmes have been carried out. Active participation of the target groups appears to be a key factor in success. Although health education makes intuitive sense, rigorous documentation and strict evaluation is necessary to provide its justification and to maximize the potential of this strategy.