Since the beginning of the epidemic, in Canada as in the rest of the world, the burden of preventing HIV infection has rested almost exclusively on sexual-health education and promotion. As the dynamics of such infection have become better understood, these strategies have been adjusted and refined: the earliest efforts were aimed only at improving knowledge of modes of transmission and means of prevention, whereas today the most promising educational strategies combine community mobilization and empowerment at the levels of both the individual and the collectivity. They take into account not only individual risks but the social vulnerabilities associated with, for example, discrimination, poverty, and power relations.
Nevertheless, the epidemic continues to grow, which has allowed many to conclude that prevention based on these educational strategies has failed. Defending these efforts in Berlin in 1993, Lamptey et al. (1993) confirmed their value with respect to supporting individuals in modifying their risky sexual behaviours or in adopting and maintaining safety practices, as well as in creating more favourable attitudes towards safer sex. In their view, the real problem is the absence of the explicit political and societal will required for these experiments to be applied on a broader scale. Thus, the apparent failure of prevention does not mean that educational strategies are ineffective; rather, it reflects the inadequacy of their implementation in a socio-economic context that will make success even more difficult to achieve in the future (Barrett, 1994; references for Chapters 1 and 2 are at the end of Chapter 2).
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