Condoms and CFLs: Environmental Behavior Change Lessons from Public Health

Kimberly Rovin, MPH, Malea Hoepf Young, MPH, and Karen Hardee, PhD

Climate Change and HIV/AIDS

In 2007, the Intergovernmental Panel on Climate Change’s (IPCC) Fourth Assessment Report recognized climate change as a global issue with the potential for catastrophic environmental effects. The report stated that, “Warming of the climate system is unequivocal, as is now evident from observations of increases in global average air and ocean temperatures, widespread melting of snow and ice and rising global average sea levels.”¹ Likewise, by the late 1980s HIV/AIDS was identified as an undeniable pandemic that would affect all countries. The similarities between climate change and HIV/AIDS extend beyond the global nature of these issues, though. Both have complex etiologies, the scientific bases of which are difficult to translate to the general public, and neither is fully understood, even by experts in their respective fields. For example, the development of an HIV/AIDS vaccine continues to elude researchers largely because of an inability to understand the full extent of the virus’s extreme genetic variability and rapid mutation and adaptation capacities.² Similarly, the unprecedented changes in climate that have occurred since the Industrial Revolution, and the conflation of human-based and natural drivers, prevent a definite attribution of climate change to any specific cause.³ Lastly, neither climate change nor HIV/AIDS are visible threats on a day-to-day basis. Once infected with HIV/AIDS, an individual may remain symptom-free for up to 10 years, obscuring internal disease progression, while climate change is a result of greenhouse gas emissions compounded over many decades, with few noticeable daily effects.⁴

Overall, the connection between HIV/AIDS and environmental behavior change lies in the global nature and the sheer enormity of these issues, the complexity of behaviors needed to alleviate them, and the necessity of a multilevel approach for significant and sustained changes. Both HIV/AIDS and climate change require addressing sensitive behaviors – sexual behavior for HIV/AIDS and the global distribution of resources and consumption use for climate change – which may lead to issue avoidance. Further, behavior change related to HIV/AIDS and climate change involves the adoption of innovations intended to prevent future rather than immediate events. For example, the well known “ABCs” HIV prevention measures (Abstinence, Be faithful, Condom use) call for specific behavior changes to reduce the risk of future HIV infection, but offer few immediate benefits.⁵ Actions taken to mitigate climate change impacts, similarly, will have no effect until at least 2030 due to the climate change processes already underway.⁶

HIV/AIDS and climate change also have parallels with regards to alleviation efforts. For climate change, mitigation (preventing further climate changes by reducing greenhouse gas emissions) and adaptation (implementing measures to deal with the already occurring changes) are both important strategies. Likewise, HIV/AIDS amelioration relies on prevention and treatment efforts. Moreover, for both of these issues, a combination of prevention/treatment or mitigation/adaptation is necessary in order to affect the most positive changes.⁷, ⁸ However, despite the proven successes of various HIV prevention programs around the world, long-term effects are difficult to achieve, and after one year positive behavior changes often decline significantly. Barriers to sustained prevention include the complexity of behaviors required (e.g., continuous use of condoms), underlying social norms (e.g., norms that support risk-taking behavior), and the physical environment (e.g., the availability and accessibility of resources needed for prevention). ⁹ Environmental behavior change strategies are threatened by the same set of barriers.

Addressing both climate change and HIV/AIDS requires changes at multiple levels from the daily decisions made by individuals, community beliefs and attitudes, and movements for policy change. Furthermore, global partnerships and collaboration are crucial for climate change and HIV/AIDS alleviation. Within the HIV/AIDS arena, efforts by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Global Fund to Fight AIDS, Tuberculosis and Malaria demonstrate international concern and commitment to HIV/AIDS. For climate change too, some steps have already been taken; for example, the Kyoto protocol (which entered into force in 2005) marked an international commitment to reducing greenhouse gas emissions by industrialized countries.¹⁰ Kyoto’s first commitment period is set to end in 2012 requiring a new framework to reduce global greenhouse gas emissions, and UNFCCC (United Nations Framework Convention on Climate Change) meetings in Bali in December 2007 culminated in an international agreement to define a global limit on emissions by December 2009.¹¹ These policy initiatives will need to be bolstered by actions taken by individuals and communities, and will necessarily involve significant behavior changes.

However, caution must be taken in evoking fear, a common tactic in behavior change strategies and one easily applied to global climate change. Lessons from HIV/AIDS behavior change communication demonstrate the harm in promoting fear without simultaneously providing information and alternative behaviors. Looking to public health, especially public health’s response to HIV/AIDS, for help in promoting environmental behavior change represents a unique strategy with wide-reaching potential. Decades of public health research and practice in the area of health behavior have built an extensive base of behavior change theories. This paper explores ways in which public health behavior change strategies can inform environmental behavior change communication on individual, community, and policy levels. Specifically, examples of health behavior strategies frequently used in HIV/AIDS literature are highlighted to draw parallels between HIV/AIDS prevention and climate change mitigation.