Highlights and Themes
HIV is transmitted from person to person. Each infected person interacts with other individuals in a variety of relationships, is a member of at least one cultural group, belongs to some type of community, and lives in specific social and economic environments. Thus, the conditions under which individuals transmit HIV to others vary in a highly complex manner across individuals, families, groups, neighborhoods, regions, and countries. Such variation, combined with the charged issues of transmission through sexual contact and drug use, presents a compelling challenge to the design and implementation of effective public health measures to control the AIDS epidemic. Even if a vaccine to prevent HIV infection became available tomorrow, the lack of understanding of how to intervene effectively in the strong social and behavioral forces that influence risk for HIV infection would undercut the success of global vaccination programs.
The workshop participants identified themes and priorities relevant to a research agenda for HIV/AIDS in the next decade. The major theme of the workshop for policymakers is that programs to encourage and bolster use of social and behavioral methods in research supported by the National Institutes of Health, the Centers for Disease Control and Prevention, and other agencies will be good investments for the future. In addition, the following themes and research needs were prominent:
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Efforts to prevent HIV/AIDS will require broader perspectives than those that have been applied in the past. The focus of research must be not only on the natural course of the physical illness but also on the social course of the
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disease. Rather than focusing solely on the individual, researchers must study the broader social context—including couples, partners, networks, communities, and global issues—for the effects of context on risks and diffusion and for the potential that social context may hold for intervention.
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This research will require the viewpoints of a wide variety of behavioral and social scientists. Such researchers would include psychologists, anthropologists, historians, economists, sociologists, and political scientists.
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A clear gap exists between the tradition of clinical social science investigation and the need to see risk behaviors in a broad social, political, economic, and cultural context. Strategic planning could help determine the types of interdisciplinary collaborations that are required and methods to foster such collaborations.
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Epidemiological, geographical, and spatial variability of HIV infection in the United States and throughout the world needs to be better described and understood in the context of factors such as social upheaval and disintegration of communities.
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Models for understanding the spread of HIV and for the development of preventive interventions must also take into account social forces, such as poverty, war, child abuse, and many other factors. NIH and CDC are not specifically charged with intervening in such social problems. Efforts to stop the spread of HIV, however, will be sharply limited without the consideration of their import.
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Efforts are needed to improve and expand behaviorally based and socially based prevention interventions and to integrate them with biomedical interventions.
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Careful identification of subgroups of high-risk populations would facilitate more strategic design of preventive interventions. Such identification should include demographic measures, such as age, race, and gender, as well as measures regarding how people identify themselves with certain social networks and communities.
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Lessons from prevention research in the fields of pregnancy, smoking, obesity, radon, mental disorders, and occupational safety and health can also facilitate design of HIV/AIDS preventive interventions. Comparison of design, evaluation, and outcome problems and attempts at resolution might yield productive clues and save some valuable resources in the HIV prevention field.
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Studying the risks, diffusion patterns, and solutions in other countries may provide valuable information for the design of U.S. prevention programs.
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Attempts to merge or synthesize the theories and models from various scientific disciplines into one overarching framework would be misguided. Similarly, no one intervention can deal simultaneously with the individual along with multiple social contexts. Interventions will need to be targeted, with differentially targeted interventions occurring simultaneously. The crucial task
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in evaluation will be to assess the specific impact of each of these interventions.
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A contextual analysis model that would link macrolevel work, such as epidemiological surveys, with the kinds of insights that are gained from ethnographic work could be useful.
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HIV/AIDS preventive intervention research requires careful prior consideration and analysis of ethical conflicts and the development of adequate mechanisms for their adjudication.
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One-to-one preventive interventions have limited utility; social structures must also be used, even in disintegrating communities where informal structures and lines of communication may be difficult to identify.
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To achieve the maximum benefit from socially and behaviorally based HIV/AIDS prevention strategies, prevention programs and projects require careful evaluation and analysis.
