Social barriers to effective HIV prevention

Beschreibung

This thesis was written in 2008 after six months of field work and data collection in South Africa. It includes a comprehensive literature review on the theory and empirics of the behavioural response to HIV looking at: (1) the relationship between HIV incidence and sexual behaviours; (2) types of evidence resulting from observational studies, randomised controlled trials (RCTs), recent creative social experiments that go beyond conventional RCTs in testing different hypothesis in the field; (3) the socio-economic characteristics of HIV infection and associated sexual behaviours. The research and analysis is informed by the social perspective on HIV prevention, an approach that assumes the presence of community-level factors that influence sexual-health outcomes. The innovative role and potential to induce social change of sports in development and HIV prevention is highlighted by discussing the theoretical frameworks of two soccer-based programmes (Grassroot Soccer; Whizz Kids United) and how they address social drivers of sexual-risk behaviours in the context of a generalized epidemic. New evidence is generated through regression analysis and a six-month follow up field experiment contributing to the understanding of stigma and peer pressure as major social drivers of HIV in South Africa. Well designed sports-based programmes are highly promising to curb the spread of HIV even in the worst affected countries where the riskiness of the sexual network explains why behaviour change programmes that focused on the individual did not prove efficacious at the population level. Academic peer-reviewed evidence to underpin the long-term benefits suggested here is practically non-existent and should be the concern of future research.