Possible Research Areas:

- Research into the mechanisms of scaled-up programmes (scale-ups from functioning community projects). Studies into scale-ups of intervention that has been tested at community level. How do we overcome the gap between the normal approach of RCT’s at community level and the fact that radical changes are needed in a sufficiently large number of people to have any measurable effect. This is needed both for biomedical (including adherence science), behavioural and structural scale-ups. This could include research into how to change focus from single interventions and individual behaviour to larger scales of intervention and larger population groups. This could also include research into how to alleviate risk aversion and thus enable willingness to undertake long-term strategies such as prevention with less instant results. Both in terms of managers and donors.

- Which strategies for combining scientifically derived evidence with local and community level wisdom and ownership have been tried, and which ones have worked?

- Which society changing strategies (structural changes) have been tried as HIV/AIDS prevention? Analysis and understanding of which hindrances there is to this.

- Evidence-based research into available behavioural and structural interventions in specific areas or populations.

- Research into which additional measures should come with male circumcision to avoid risk compensation (feeling more safe leads to more risky behaviour). Identification of which populations or countries are in need of this. Development of indicators for circumcision programmes.

- Establishment of the use of condoms at population level (adherence to consistent condom use). This would probably entail a lot of surveys.

- Research into whether different measures are needed at different stages (ages) of en epidemic. E.g. looking for correlation between successful campaigns and the age or development stage of the epidemic.

- Research into whether male circumcision protects female partners by reducing transmission of the virus. I.e. looking at incidence before and after circumcision programmes.

- Research into how to test new biomedical interventions with the combination prevention regime which seems to make RCT’s undesirable. I.e. development of new assessment methods.

- Research into both how to measure and how to improve adherence. Which factors is it dependent on (e.g. people who are already infected might be more willing to adhere to treatment than those who’re only at risk).

- Research into which additional information can be gathered from already obtained or routinely obtained data (e.g. from antenatal clinics).

- Research into seroconcordant negative couples to understand how to prevent infection outside – and thus inside – of the relationship.

- Research into assessment tools of various ways of HIV education, e.g. workplace peer education, community peer education, theatre groups with dramatised messages, local and international media (e.g. local newspapers or radiostations versus MTV’s “Staying Alive”), innovative use of modes of communication (e.g. Swaziland’s “Secret Lover” SMS campaign). This is probably context dependent, too. How to overcome the gap between “Oh, that’s interesting” and “This concerns me and my life”. Research into scale-ups of these strategies (social-cognitive, educational strategies), which have almost always been delivered as some sort of education of individuals or small groups, and expansion of this to national levels have not been tried, tested or assessed (except in terms of secondary school sexual education). Research into why myths flourish and some people (and which extend of people) find it easier to believe in myths and e.g. are more willing to violate infants than go for ARV treatment.

- More sero-epidemiological and behavioural-epidemiological studies in one country or one area are needed.

- More research into serodiscordant couples in long term relationships and what is needed to keep the seronegative partner negative. Here especially the challenges of controlling viral loads and this infectiousness in environments in which constant monitoring of viral loads and CD4 counts and such are not possible, or the development of other methods to protect the seronegative partner from becoming infected. This is also adherence science.

- Research into risk compensation itself, e.g. in connection with male circumcision programmes.

- Comparison of success rates of HIV/AIDS programmes that incorporate structural approaches to those that don’t. Indicators for this. Conceptual and technical definition and implementation of structural approaches, development of assessment tools suited to their long-term nature. Taking into account that evaluation requires routine process assessment of interventions. Are different indicators and different assessment tools needed depending on the proximity or distality of the structural intervention? Comparison between projects with a high level of local ownership and those with a high level of top-down leadership. Indicators for this. This includes some extend of identification of the causal pathways.

- Research into which empowerment of women programmes have been implemented (in terms of income generation, redressing gender inequalities, sexual coercion or violence, etc.) and which outcomes they have had, or whether this has been assessed. Is there a correlation with other societal inequalities like lacking democratic control with the government or prevention from voting in elections? Is there a correlation with the Social Development Index? The Gini coefficient (the broader the gap between the richest and the poorest, the higher the prevalence rate)?

- Identification and contextual analyses of how social, political, economical and environmental factors are operating and influencing vulnerability and risk and the causal pathways between the structural factor and the behaviour or behaviours leading to risk in a given community. A structural change will most likely need to be worked on several levels along the causal pathway. Assessment of success or failure of a project must also assess its effect on the elements of the causal pathway. Improving on assessment methods seeing as RCT’s are not well suited to test structural interventions. Analyses of which factors affect the epidemics proximally and which ones affect it distally. Assessment of how best to address these factors. It is highly possible that these should be handled differently depending on both context and proximity or distality.
- Research into the social, economic, political and environmental conditions in which specific HIV/AIDS programmes are implemented and into which influences they have had on the outcomes. Documentation of these differences and exploration of the mechanisms by which an intervention works for a particular group. E.g. comparisons between what worked where.

- Studies of HIV/AIDS prevention programmes in cooperation with the NGO’s or Governmental Organisations running them (the people implementing them), as these organisations tend to try to redress structural factors in innovative ways but lack the scientific knowledge of assessment tools to make significant analyses of the outcomes. Studies into how many NGO’s or other organisations have data that they cannot process, like the Swazi organisation TASC, that made an anonymous survey among its users and had no way of processing the data thus obtained.

- Development of powerful and user-friendly analyses models or software that catch not only the current pattern but also emerging trends. I.e. prediction of where the next 1,000 infections will occur so that those at risk can be targeted. This means understanding the underlying patterns of epidemiology and why and how they change and implementing this into models.

- Research into which project sites work better and into which factors contribute or subtract from effectiveness in context. This would make most sense by comparing different sites from the same project or a few projects, selected so as to have more than one site. This should be done in cooperation with an NGO or other organisation running the projects.

- Research into what prevention approaches work best, where, for whom, and why.

- Establishment of “early warning systems” of changes in epidemiological trends much like those warning against Tsunamis or earth quakes. This is very narrowly connected with trying to identify where the next 1,000 infections will occur. Research into how the epidemiological patterns change with the age (maturity) of the epidemic. Development of powerful and user-friendly analyses models or software that catch not only the current pattern but also emerging trends. I.e. prediction of where the next 1,000 infections will occur so that those at risk can be targeted. This means understanding the underlying patterns of epidemiology and why and how they change and implementing this into models.

- Research into what facilitates systematic implementation of prevention programmes, what bottlenecks hold up progress, and what strength of effort will be necessary. E.g. the Avahan Programme or the Three Ones in India, as well as social involvement at community level and building of capacity and community infrastructure. This is a structural approach, too, and linked with trying to identify the change-averse factors in a society.

- Research into the actual role and contribution of concurrency in the spread of HIV, and to which extend it works alone or in concert with other factors such as low rate of male circumcision, mobility, family separation, religion, and other cultural factors. Establishment of recommendations on concurrency for all HIV prevention efforts.

- Establishment of which (additional) areas a HIV/AIDS prevention effort must address (e.g. mitigation of the negative consequences of the epidemic). The authors recommend that they must at least incorporate HIV prevention as an integral part of a country’s development plan, active engagement of multiple sectors in government and civil society, effort effectively led at state level. E.g. a comparison of the additional factors (more than this) that successful HIV/AIDS prevention programmes have in common.