Other results

One significant finding was that interventions that increased participants’ sense of the threat of HIV or of related outcomes such as STIs or pregnancy had a consistently negative effect, across all categories of recipient.

Put simply, if you frightened people about HIV they used condoms less, not more. Remember that nearly half of all programmes included some element of threat arguments. There’s further discussion of threats and fear-based approaches later in this chapter.

Normative arguments (appeals to social responsibility) did not work either, except with young people under 21. Otherwise, in fact, young people were rather a resistant audience, showing much less tendency to use more condoms after interventions.

Men responded particularly badly to threat arguments and women responded badly to normative arguments, though both sexes responded equally well to behavioural-skills training.

Africans and African-Americans responded badly to both threats and normative arguments, though they did respond well to general training in interpersonal skills, as well as specific skills, unlike whites and Latinos. All groups responded well to teaching behavioural skills, not just in condom use but in management skills such as safer-sex negotiation.

High-risk groups (including gay men) generally did not respond as well as low-risk groups, but this may have been a statistical effect whereby groups that already had relatively high levels of condom use did not increase their use as much as groups that initially had low levels. They responded particularly badly to normative and attitudinal arguments. But they responded well to condom provision and condom-use training.

Albarracin acknowledges that if she had used sexual abstinence or partner reduction as the outcome measure, threat arguments might be found to work. Scaring people may be a legitimate tactic in health promotion if you want to stop people doing something, such as smoking cigarettes or drink-driving. It’s much less likely to get people to take positive self-protective steps such as using condoms.

One finding was the striking paucity of trials of programmes for HIV prevention aimed at people with HIV. Seroprevalence data among trial groups was only available in 22 of the 354 trials, “which,” comments Albarracin, “severely limited the possibility of analysing the different intervention components.” Albarracin was able to show that the higher the HIV prevalence was in groups of participants where it was reported, the more positive the behaviour change which, as she comments, “indicates that HIV positive people generally increase their condom use”, a finding backed up by other studies.

In relation to people with HIV, the lack of statistical power meant that only attitudinal arguments encouraging condom use, fear-inducing arguments about the consequences of not using them, and condom provision could have their effectiveness measured. Fear-inducing arguments and condom provision had a neutral impact. But attitudinal arguments actually had a negative impact on people with HIV: programmes that did not try to get HIV-positive people to have a more favourable attitude towards condoms worked better than ones that did (p = <.001).

Albarracin’s finding that just 3% of papers addressed mass-media campaigns also underline the paucity of research into the effectiveness of this kind of intervention.

We will return to Albarracin’s meta-analysis when we look at the theories of behaviour change that underlie the planning of prevention programmes.