Prevention Measures

Combination Prevention is a rights-based, evidence-informed, and community-owned program approach that uses a mix of biomedical, behavioral, and structural interventions, prioritized to meet the current HIV prevention needs of particular individuals and communities, so as to have the greatest sustained impact on reducing new infections.

The goal of combination prevention is to reduce the transmission of HIV by applying a combination of behavioral, biological, and structural interventions that are carefully selected to meet the needs of a population. Also, because individuals’ HIV prevention needs change over a lifetime, combination approaches help ensure that people have access to the types of interventions that best suit their needs at different times.

Biomedical interventions are those that directly influence the biological systems through which the virus infects a new host such as male and female condoms, anti-HIV treatment as prevention, and voluntary medical male circumcision.

Behavioral interventions include a range of sexual behavior change communication programs that use various communication channels (e.g., mass media, community-level, and interpersonal) to share behavioral messages designed to encourage people to reduce behaviors that increase risk of HIV and increase protective behaviors (e.g., risks of having multiple partners and benefits of using a condom correctly and consistently). Behavior interventions also are aimed to increase the acceptance and demand for biomedical interventions.

Structural interventions address the critical social, legal, political, and environmental enablers that contribute to the spread of HIV. Widely used categories to describe structural interventions include: legal and policy reform, reducing stigma and discrimination against people living with HIV and marginalized groups, gender inequality and gender-based violence, economic empowerment and other multi-sectoral approaches, and education.

Over the last decade, lead HIV agencies have recommended the use of “combination prevention” approaches to reducing HIV infections. However, simply combining interventions is not enough. To achieve greater reductions in new infections, prevention strategies need to be combined in the smartest and most efficient ways possible for each of the populations affected by the epidemic.

Perhaps the need to do more with resources is greater today than ever before. The global economic crisis has lead to significant reductions in HIV prevention demanding greater efficiency and impact from each dollar spent.

This approach guides the movement of prevention resources as well as the development of specific prevention strategies for all at-risk populations including Men Who have Sex with Men, other at risk men, female sex workers, youths and others.

Treatment as Prevention

Studies have demonstrated the benefits of ART for the prevention of HIV transmission. There is evidence that individuals on effective anti-HIV treatment who are properly keeping with treatment, are less likely to spread HIV to others. Conversely, those unaware of their HIV status may spread HIV to their partners. At the individual level, ART reduces viral load and infectiousness, making it a prevention method.

Recognizing the value of mass communication in prevention, a number of public education initiatives have been taking place. The MOH has been implementing throughout the year and especially during World AIDS Week activities “Know Your Status, Get Tested Today Campaign.” In addition, mass media are used to inform and educate the general public on PMTCT. PASMO is one of the principal civil society organization implementing mass media campaigns in the country.

These campaigns are primarily geared towards condom use through the “Got it. Get it” slogan. Belize also benefits from the regional mass media campaign Live Up!” which is delivered through the local affiliate of the Caribbean Broadcasting Media Partnership Against HIV/AIDS.

The Belize Family Life Association (BFLA) also uses mass media to promote SRH services as well as condom use. The Belize Red Cross uses billboards to bring awareness through the “Faces” campaign. The current Global Fund (GFATM) Round 9 grant to the Belize CCM is filling an important gap in mass media campaigns by targeting young persons with a Behavior Change Communication (BCC) campaign addressing delayed sexual activity, partner reduction, and safer practices among youths between 15 – 24 years old.

This is a first attempt to design and deliver a coordinated national mass media campaign targeting young people, based on the evidence gathered from the Belize Sexual Behavior Survey of 2009.

Targeted & Community Outreach

Since evidence of most at risk populations has been unavailable until recently with the publishing of Behavioral Surveillance Survey (BSS) of 2012, targeted prevention initiatives have almost been non-existent. Instead, prevention targeting some populations assumed to be at risk is mainly guided by anecdotal evidence.

The BSS of 2012 documented prevalence rates of 13.85% in men who have sex with men and 0.91% in Female Sex Workers. National statistics is also supporting the notion that some groups of men bear the larger share of the HIV/AIDS burden and targeted interventions are necessary in achieving equity in health and to reduce the spread and impact of HIV transmission.

The Youth for the Future (YFF) department of the Ministry of Education and Youth (MOEY) and the NGO GoJoven, provide young persons who are out-of-school with information and education on ways of preventing the transmission of HIV. The NGOs, Youth Enhancement Services (YES) and Young Women’s Christian Association (YWCA), provide young girls, at-risk of early pregnancy and HIV infection, with advocacy, education, and economic empowerment services. The Alliance against AIDS (AAA) provides services to persons with HIV, including educational and prevention programs

In 2008, AAA initiated, in collaboration with the Women’s Issues Network of Belize (WIN-Belize), the Sexual Health and Sexuality Education Program as a New Prevention Technology for women in urban and rural areas. The program includes training of educators on Sexual Health and Sexuality, as well as outreach with women in poor neighborhoods and rural villages. Target audiences include youth, Men Who have Sex with Men (MSM), prisoners and persons with HIV.

The newly formed NGO of and by person with HIV, C-Net+ actively engages persons with HIV in key actions for change as well as deliver a wide range of capacity building, leadership, and empowerment building opportunities. BFLA also provides outreach services to sexually diverse populations in Belize, including SRH education to youths, MSM, FSW, and persons from the lesbian, gay, and bi-sexual and transgender community. With funding from the US Department of Defense, and guided by the results of the SBS of 2009, the Charles Drew University provides education and prevention services to BDF soldiers.