کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
952436 | 927515 | 2012 | 7 صفحه PDF | دانلود رایگان |
This manuscript draws connections between chemoprophylaxis and the biomedical model of disease that emphasizes individual behavior. We argue that chemoprophylactic HIV interventions have limited utility at the population-level, and that structural interventions need to be prioritized. We use the recent CAPRISA 004 and iPrEx trials to (a) critique the utility of these trials from a public health perspective by highlighting the difference between efficacy and effectiveness, (b) apply an alternative theory of health behavior as a way to reorient the field toward the discussion of the need to employ structural interventions, and (c) examine two aspects of HIV prevention efforts – funding structures and iatrogenic effects of biomedical approaches – as a means of overcoming obstacles to more widespread adoption of structural interventions.
► CAPRISA 004 and iPrEx are efficacy trials; these interventions will have limited effectiveness in populations.
► Human behavior is the product of autonomy and structural constraints; this highlights the primacy of structural change.
► Individually focused interventions, whether behavioral or biomedical, will have limited utility without structural change.
► Our funding structures reflect biomedical thinking; there is little room to develop or evaluate structural interventions.
► Utilizing individually focused interventions can increase stigma within communities.
Journal: Social Science & Medicine - Volume 75, Issue 9, November 2012, Pages 1555–1561