Against the background of debate about the nature of risk in relation to HIV transmission, and resultant changes in risk discourse from risk group to risk behaviour to risk situation, declines in the velocity of HIV spread are being documented in countries with high levels of political commitment and multi-sectoral approaches. Biological markers of sexual activity such as sexually transmitted disease incidence and HIV prevalence corroborate reports that young adults in Uganda and Thailand are increasingly adopting preventive behaviours. Risk perception, perceived social and community norms and self-efficacy influence behavioural change, but structural and contextual factors, including resource constraints affecting HIV prevention programmes and the treatment of sexually transmitted diseases, and social marginalization and stigmatization affecting access of vulnerable populations to the means of prevention play determinant roles. Both patterns of risk for HIV infection and our understanding of them are evolving. More research is required to gain knowledge and understanding of factors such as partner concurrency as well as cultural and socio-economic determinants and contextual underpinnings of sexual and drug injecting networks. This is an essential first step to mobilizing communities to take action at the individual, partnership and community levels to reduce risk.
PIP: The focus of analysis in the international discourse about HIV transmission has shifted from risk group to risk behavior and now to risk situation. This encompasses the political, legal, social, economic, and environmental factors that determine vulnerability to HIV. For example, the structure of sexual networks--especially whether a person has more than one concurrent partner or practices sequential monogamy--is more important to defining an individual's HIV risk than the actual number of sexual partners. In both Uganda and Thailand, changes in the contextual environment have been associated with clear reductions in HIV prevalence and incidence. In Uganda, declining HIV incidence has been attributed to high-level political commitment, later age at sexual debut, condom use in high-risk sexual relationships, reductions in numbers of sexual partners, and increased monogamy. Salient factors in Thailand have included a view of AIDS as a national development issue, a broad multisectoral strategy, provision of free condoms to commercial sex establishments, and educational campaigns through the mass media.