of interventions—behavioral or medical—will be sufficient by itself to combat the epidemic. More behavioral and social research is needed to develop effective and acceptable preventive strategies to refine successful programs and to help find more effective ways of mitigating the negative impacts of the epidemic.

The interpretation and utility of much epidemiological, behavioral, and social research have been limited by the lack of a multidisciplinary approach. Data on reported behavior change may be difficult to assess in the absence of biological validation that such change is reducing STD/HIV infection. Efforts to model the demographic effects of the HIV/AIDS epidemic are hindered by a paucity of data sets that combine fertility, mortality, migration, and other sociodemographic information with HIV serology. Conversely, serological studies that fail to collect adequate behavioral data miss an important opportunity to assess the effects of key factors in the spread of HIV, such as sexual practices and sexual networks within given populations. The design, execution, and analysis of clinical trials for STD control, HIV vaccines, antiretroviral drugs, and genital barrier methods and virucides all depend on appropriate behavioral research to guide enrollment; ensure adherence to trial protocols; and permit adequate interpretation of epidemiological results, including the very basic need to control for differential behavioral change between study groups.

Until new research is available, it is critical to keep trying the existing strategies that are believed to be most effective, as well as designing new and innovative ones. The epidemic is forcing people to rethink their values and behavior, and is changing the social context. Strategies and policies must be responsive to the ever-changing situation, as well as receptive to the findings of research being carried out throughout the region. An effective partnership between research and program interventions will be key to lessening the spread and impact of the HIV/AIDS epidemic in sub-Saharan Africa.



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