ABSTRACT
Effective and rigorous evaluation of social interventions in the HIV prevention and sexual health-education fields has often been dismissed as unethical, impractical, or both. The randomized controlled trial favoured in recent years by doctors and other health professionals in situations where there is uncertainty about whether a treatment or programme works is particularly unlikely to be used in the HIV prevention field. Randomized control requires allocating individuals to experimental and control groups, with the latter receiving no intervention. The perceived moral urgency of the HIV/AIDS epidemic and the ethical issues involved in denying high-risk groups any intervention which may be effective are particular problems for this method of evaluation. In this chapter we will discuss the findings from a survey and evaluation of studies of interventions in HIV prevention and sexual health education. We will provide an overview of the different approaches that have been employed in these fields, paying particular attention to the method of evaluation. We will discuss the problems and potential of randomized controlled trials, illustrated by those studies in our survey that have used the approach. Interventions designed to prevent the transmission of HIV by reducing risk behaviours offer the only chance of limiting the spread of the epidemic. Modern medicine and molecular biology have had little impact on the spread of HIV. Although there have been some advances in secondary prevention and the treatment of opportunistic infections in the developed world, a successful vaccine is unlikely for some years (Cohen, 1993; Sittitrai et al. 1990). Even where effective therapies do exist for sexually transmitted diseases, their spread
cannot be successfully contained by medical therapies alone; modes of infection are rooted in social mores and environmental factors related in complex ways to the biology of disease. Preventing the spread of such diseases calls for a detailed understanding of the determinants of risk-taking behaviour in different social groups, and demands that the construction of intervention strategies should be based on this understanding.
