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An Expanded Behavioral Paradigm for Prevention and Treatment of HIV-1 Infection

Coates, Thomas J. PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: July 1st, 2013 - Volume 63 - Issue - p S179–S182
doi: 10.1097/QAI.0b013e318299eff0
Supplement Article

Abstract: This article addresses behavioral and social research priorities for prevention and treatment of HIV-1 infection. The approach used to define these priorities is based on 3 premises: (1) Behavioral interventions for prevention and treatment are necessary but not sufficient for producing reductions in transmission or advances in treatment; the same is true of biomedical interventions, and by themselves, they cannot maximally impact the health of communities. (2) Combination prevention and treatment strategies should include optimal combinations of behavioral and biomedical strategies but also must include the varieties of the behaviors of individuals, communities, and systems needed to ensure effective treatment and prevention. (3) And it is no longer useful, given scientific advances in understanding how treatment contributes to prevention, to discuss prevention without incorporating treatment and vice versa. This redefinition of behavioral approaches in combination prevention and treatment provides a new paradigm for defining behavioral research in HIV-1 disease. No longer is it sufficient to focus on single behavior (eg, high-risk sexual behavior, adherence to antiretroviral medications) of individuals in a vertical way. Rather, the behavioral agenda not only need to expand to encompass traditional investigations of single behaviors but also need to include the behavior of many actors and systems that are essential in facilitating reductions in transmission and improvements in treatment outcomes. In addition, there is the need for expanded implementation research agenda to encompass the study of methods to achieve high coverage, acceptability, and effectiveness of available menu of interventions.

Center for World Health and Division of Infectious Diseases, David Geffen School of Medicine and UCLA Health System, University of California, Los Angeles, CA.

Correspondence to: Thomas J. Coates, PhD, 13-154 Center for Health Sciences, Los Angeles, CA 90095 (e-mail:

Supported by the HIV Prevention Trials Network through the following award: UM1 AI068619.

The author has grant/grants pending with the NIH and has been reimbursed for travel by the NIH.

The author has no conflicts of interest to disclose.

© 2013 Lippincott Williams & Wilkins, Inc.