Sexual Behavioral Modification, STD Treatment Do Not Reduce HIV Incidence in Ugandan Rural Communities, Study Shows

A large trial examining whether sexual behavior modification and sexually transmitted disease management could cut HIV transmission in Africa had "no effect" on HIV infection rates during the three-year study, London's Times reports. The study, which is published in the Feb. 22 issue of the Lancet, involved distributing 1.5 million condoms, treating 12,000 STD cases and counseling 15,000 people on HIV prevention strategies (Hawkes, Times, 2/21). Researchers from the Medical Research Council Program on AIDS in Uganda and colleagues examined 96,000 people age 13 or older in 18 rural communities in Uganda between 1994 and 2000 (Kamali et al., Lancet, 2/22). The researchers divided the study participants into three groups: the first received information and advice about reducing risky behaviors; the second group received this advice plus treatment for existing STDs; and the third group served as a control group (Times, 2/21). They examined the groups to determine the incidence of HIV, herpes simplex virus-2, active syphilis, gonorrhea, chlamydia, genital ulcers and "markers of behavioral change" (Lancet, 2/22).

Results
The study showed that the interventions resulted in "no measurable reduction" in the number of new HIV cases, but they did detect "significant" drops in syphilis and gonorrhea cases, the Times reports. The study also found that although sexual behaviors were influenced -- the proportion of participants reporting casual sexual partners dropped from 35% to 15% and the proportion who said they had used a condom with their last sexual partner increased from 21% to 65% -- the number of new HIV cases was "much the same" across the three groups, according to the Times. In an accompanying commentary, Judith Stephenson and Frances Cowan of the Royal Free and University College Medical School write that the study might have been "the right trial done at the wrong time," when people were already beginning to reduce their risky behaviors. They add, "Many people will be disappointed" by the lack of impact on HIV rates, despite an "apparently appropriate intervention that reduced other STDs and was implemented on a huge scale with great care and commitment in a stricken country" (Times, 2/21). Stephenson and Cowan conclude, "The evaluation of complex behavioral interventions is challenging, but expertise in this area is accumulating. The development, piloting and full-scale evaluation of promising interventions is essential to the success of HIV prevention and should receive greater priority" (Stephenson/Cowan, Lancet, 2/22).