Sex And HIV: Behaviour-Change Trial Shows No
The East African (Nairobi)
March 17, 2003
Posted to the web March 19, 2003
Paul Redfern, Special Correspondent
A UK funded trial aimed at reducing the spread of Aids in Uganda by
modifying sexual behaviour appears to have had little discernible
The trial, carried out on around 15,000 people in the Masaka region,
involved distributing condoms, treating around 12,000 victims of
sexually transmitted diseases and counselling.
However, while the trial led to a marked change in sexual behavioural
patterns, with the proportion reporting causal sexual partners falling
from around 35 per cent to 15 per cent, there was no noticeable fall in
the number of new cases of HIV infection, although there was a
significant reduction in sexually transmitted diseases such as syphilis
The trial results, which were reported in the British medical journal The
Lancet, have already aroused some controversy.
The team leader of the trial, Dr Anatoli Kamalai, acknowledged that
there was "no measurable reduction" in HIV incidence with "no hint of
even a small effect."
But the research team's view is that the spread of HIV was already
declining in the area and the trial might not have been big enough to
detect any additional change.
There is, however, another view which has recently been put forward
which claims that inadequately sterilised needles across Africa have
led to a greater rate of HIV infection than sexual contact.
It is a view put forward by a mainly American group of scientists,
including Dr David Gisselquist, who told the Times of London that
"Results from the Masaka study add to the already long list of findings
from other studies that don't fit the hypothesis that most HIV in African
adults is from sexual transmission.
"These results from Masaka are similar to results published earlier
from a similar study in Rakai, Uganda, where interventions that
reduced STD prevalence had no impact on HIV incidence." However,
such a view is by no means mainstream in the latest thinking on the
spread of HIV in Africa.
Most scientific research still believes that HIV is mainly spread by
sexual transmission and that people suffering from STDs are
The trial was the first systematic attempt on a large scale to assess
whether modifying sexual behaviour and better management of other
sexual diseases could cut the transmission of HIV in Africa.
In a commentary in The Lancet, Judith Stephenson and Frances
Cowan of the Royal Free and University College Medical School in
London acknowledged that "many people will be disappointed by the
lack of reduction in HIV incidence, despite an apparently appropriate
intervention that reduced other STDs and was implemented on a huge
scale with great care and commitment."
The two researchers suggest that it might have been "the right trial and
the wrong time" - when HIV incidence was falling and when there were
already substantial reductions in risk behaviour.