Current approaches to HIV prevention in sub-Saharan Africa: how responsive to

couples needs?
The author talks about 2 things, Media-based interventions and Facility-based
interventions under this.
Media-based interventions
Broad-based HIV/AIDS information programs, be they referred to as Information
Education and Communication (IEC) or Communications for Behavior Change, and
which use the electronic and printed media to promote HIV/AIDS awareness and
behavior change, have been common in sub- Saharan Africa since the mid-1980s. These
are directed toward towards those that are identified as more inclined to engage in higherrisk sexual behaviors.
While media-based programs occasionally described voluntary counseling and testing,
they infrequently provided specific messages characterized by unidirectional information
flow. Members of mass media audiences rarely had opportunities to ask questions or
obtain clarification on issues pertinent to their particular situations. While media- based
efforts by national AIDS programs in sub- Saharan Africa have contributed to increased
levels of HIV/AIDS awareness and some improvements in knowledge about HIV/AIDS,
their impact on behavior change outside a few high-risk categories has been much more
modest. Only two countries in Africa; Uganda and Senegal are often cited as examples of
success with broader-based behavioral changes leading to a decline in HIV
seroprevalence levels.
Facility-based interventions
VCT centers represent media-based programs for communicating HIV/AIDS prevention
information. They provide health workers with opportunities both to provide clients with
information, including information on their serostatus, to work with clients on ways of
using the information, and elicit questions and discussion to ensure that clients
understand information provided. However, VCT facilities in sub-Saharan Africa are
infrequently attuned to couples needs and few couples present together for VCT. Most
VCT facilities address individual clients who request or are invited for HIV testing. In the
case of antenatal clinics, women frequent the facilities primarily for medical
consultations, not because they seek HIV testing.
In these settings VCT clients interact individually with counseling staff. After the VCT
session is over, however, many individual VCT clients return to partners in couple
relationships. Despite their non-involvement in pre-test decision making, these absent
partners can importantly affect the decisions that VCT clients make: to accept or refuse
HIV testing, to return or not for test results and post-test counseling, to disclose test
decisions and test results, and for women who find that they are infected with HIV, or to
enroll where available, in short course antiretroviral therapies, to prevent mother-to-child
transmission of HIV infection (MTCT).
Partners also affect VCT clients ability to follow through on intentions and decisions

made during VCT sessions. Effective protective action against HIV/STD infection within
couple relationships requires communication, agreement, and cooperation between
couple members. The obstacles to carrying out intended protective actions can be
particularly daunting for women in couple relationships. The responses that women
encounter to their prevention efforts with male partners may vary from silence
(indifferent to cool), to resistance and non-cooperation, to threats and physical violence.
Very little is known about the socio- sexual lives of couples in sub-Saharan Africa after
one or both members has been tested for HIV.
The unsatisfactory picture we have of how VCT clients and their partners carry out
HIV/STD risk management may result from a methodological bias of VCT programs and
studies that rely too much on individual VCT clients, particularly women, as sources of
information about both their own and their partners reasoning and actions.