in power, dictate that women should not initiate discussion of sexual practices or try to change their male partner's sexual behavior. Thus, under these conditions, programs that highlight the importance of open communication between women and their partners in order to promote condom use may be of limited value (Wermuth, Ham, and Robbins, 1992).


Through social networks, individuals are linked to neighborhoods and communities both geographic and cultural. The overlap of disparate sociocultural communities in a single geographic space is a feature of most areas in the United States. Geographic co-location creates important linkages between distinct subgroups, but it does not overcome all factors that create social distance. This fact has implications for the spread of AIDS in local sexual networks. Such networks may be based in a particular social group, but they likely include individuals from other groups as well. For example, strong sexual connections exist between members of drug-using networks and others in the non-drug-using community. As described in Chapter 2, this is a major source of HIV infection; and reaching the non-drug-using partners of injection drug users has constituted one of the most difficult challenges for HIV prevention.

Communities defined culturally often traverse geographic boundaries. In the context of AIDS, the most obvious example is the gay community, whose national political organization was instrumental in the dissemination of critical information and provision of social support and health care to gay men at a time when lethargy characterized the response of the medical community to the spread of HIV among them. The organized gay community succeeded in getting members of the larger gay community to practice safer sex. For example, the Gay Men's Health Crisis (GMHC) created support groups and dispensed needed information about HIV transmission. Thus, social organization and social context were shown to be critical factors in the reduction of risky behaviors (Schneider, 1992). Effective lobbying and media campaigns by groups such as ACT-UP convinced the government and research community to accelerate the distribution of experimental AIDS drugs, prompted the establishment of needle exchanges in many cities, and served to change the nature of public discourse about AIDS, by bringing an informed discussion of the AIDS epidemic "out of the closet."

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