Sex and HIV: Behaviour-Change 
Trial Shows No Link

East African

Magazine 
Monday, March 17, 2003

By 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 effect.

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 and gonorrhoea.

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 particularly prone.

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.

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