By Stephen G. Alege
Thirty five percent of people testing HIV positive in Kampala are repeat testers who had previously tested HIV negative. This is revealed by the latest data from USAID/Uganda Good life integrated HIV Counseling and testing Kampala project.
The repeat testers are individuals that have previously tested for HIV at least twice in a year and were negative. However, when they sought another HIV test they tested HIV positive. The project data shows that out of the over 77,000 people tested since December, 2012 over 900 repeat testers who were previous HIV negative are now HIV positive.
The change in HIV status of people, who were previously given pre and post test counseling in addition to knowing their HIV negative status, can be partly be attributed to failure to maintain positive behaviour.
This trend is in line with the emerging evidence which suggests that favourable behaviour change is seen in the short term following an intensive behavioural intervention such as HIV counseling and testing especially when the result is negative. After the intervention a person quickly regresses in behaviour, if the prevention intervention is not sustained.
The AIDS indicator survey conducted in 2011 found that knowledge of HIV prevention methods among adults stands at 90% yet the new HIV infections have continued to rise from 6.4% to the current 7.3%.
An HIV counseling and testing study trial conducted in Zimbabwe in 2010 found a significant reduction of new HIV infections as a result of a prevention intervention. Yet after about three years, recipients of the programme did not differ significantly from the general population that had not received any prevention intervention.
This showed that initially favourable behaviour stops after a certain period, as the people who received the service revert to even sometimes riskier behaviours.
Uganda is currently implementing the National Prevention Strategy 2011-2015 which focuses on Increasing safer sexual behaviour and reduction of risky behaviours. Various HIV prevention interventions are being implemented. However, most of these are short term and assume that individuals will adopt lifelong positive behaviour once they are exposed to these interventions contrary to available evidence.
We should endeavour to support and sustain the newly adopted positive behaviour long after the behaviour change intervention has ended. This enables the individual to continue holding beliefs about the threat HIV poses to their wellbeing and the effectiveness of the positive behaviour practices such as abstinence, consistent and correct condom use, being faithful to one sexual partner among others.
This kind of sustained contact enables the individual to adopt the behaviour as a norm enabling them to overcome behavioural barriers such as the difficulties in accessing a condom, the inconvenience it may bring or even the cost associated to accessing one.
These efforts should be coupled with mass media behaviour change campaigns that focus on the consequences of behaviour relapse such as the burden of taking medication for life and the associated side effects. This helps in entrenching the perception of the HIV threat and reinforcing the positive behaviour.
Therefore, we must strive:
• To link individuals that have been reached through prevention intervention such as HIV testers to appropriate post test peer support groups within their localities. These support groups should be based on relevant communal values for acceptability and sustainability.
• Set up a strong post test follow up system through the village health teams to continuously support the testers through the behaviour change stages until they graduate as advocates of the adopted behaviour.
• Conduct integrated mass media campaigns with the objective of sustaining the adopted positive post prevention intervention behaviour.
• Harness the potential of phone coverage to convey behaviour reassurance messages supporting the maintenance of the adopted positive behaviour.
The writer is a Makerere University School of Public Health-CDC Fellow
Behaviour relapse fuelling new HIV infections