Thailand—social contexts can induce risky behaviors. The hope is that changes in the same social context can help modify behavior.
When the onset of AIDS is framed more broadly than as a result of voluntary sexual acts or drug injection, personal responsibility becomes only one part of the picture. When behaviors are influenced, coerced, or socially constrained by partners, community norms, or political and economic circumstances, a collective or community responsibility becomes relevant. The following stories and vignettes were presented at the workshop or provided by individual committee members. They are included here to illustrate these points and to orient readers to the “real world” phenomena that confront the design and implementation of HIV/AIDS preventive interventions. Understanding such phenomena on an operational basis and designing strategies that effectively reduce at least some of the multiple, and often overlapping, barriers these phenomena present to public health interventions is the goal of social and behavioral science.
HIV seroconversion rates in San Francisco are estimated to be 2.6 percent per year for gay men 18 to 29 years of age, with 28.9 percent of the men being seropositive by age 27 to 29. The following case history describes a typical young gay man new to San Francisco. His name is Mark, and he is 19 years old. He was interviewed at an Sexually Transmitted Disease (STD) clinic.
Mark arrived in San Francisco shortly after graduating from high school; he is originally from Modesto, California, population approximately 100,000. Mark was discovered having sex with a high school friend in May. Mark's father confronted him and demanded to know if he was gay. Mark had not previously thought of himself as gay but could not deny it. His father told him “No queers in my house” and set an ultimatum: Mark must stop any sex with males or leave home. Mark finished high school the next month and left home. During his last month at home he and his father did not speak. His mother did not intercede.
Mark arrived in San Francisco with no place to live and $500 in savings from part-time work. Mark had previously visited the city with friends and knew that the Castro neighborhood was gay-friendly. On arrival, he went to the Castro neighborhood, where he met several other young people. One other young man, Stan, suggested that he move in with him until he got settled. Mark stayed with Stan for only a month —during which time he found a job and a place to share. He