National Institutes of Health Consensus
Development Conference on
Interventions to Prevent HIV Risk Behaviors

Statement of the
American Anthropological Association
Commission on AIDS Research and Education

January 24, 1997

On behalf of the American Anthropological Association (AAA), we thank NIH for the opportunity to address some of the issues related to interventions to prevent HIV risk behaviors. The AAA, established in 1902, is the world's largest professional organization of anthropologists. Anthropologists have conducted AIDS-related research in the US and many parts of the world since the mid-1980s. This research has been in every domain, including vaccine trials, human sexuality, gender systems, drug treatment, needle exchange, virology of HIV transmission, health care utilization and decision making. The AAA has focused attention on AIDS since 1988, most recently establishing and supporting the activities of the Commission on AIDS Research and Education.

The AAA's Commission on AIDS Research and Education seeks to expand intervention research and programs that include examination of risk within its social, economic, and cultural context. We endorse recent calls for a focus on "vulnerability" to risk and support efforts to address "structural and enabling approaches" to HIV prevention. HIV intervention programs have traditionally focused on individuals, and research and evaluations of individual level intervention programs have continued for more than a decade. We call for a shift in focus from the individual to the community to understand the broader setting within which individual risk occurs. This change in focus will enable us to identify social and contextual risk factors that predispose individuals and communities to HIV and to develop more effective intervention programs.

It is clear that individual-level risk reduction programs can only have limited effect without fundamental changes in the social and economic conditions of vulnerable persons and populations. With the AIDS epidemic increasingly focused in the poorest countries in the world and in the poorest communities in developed nations, there is increased urgency to address the broader social and economic factors that create vulnerability for persons and communities. Paramount among these factors is poverty and inequality which impact on exposure to risk and on the capacity for risk reduction as well as access and utilization of health care.

While many public health advocates acknowledge the importance of social and economic factors, including poverty and inequality, to health, most feel understandably frustrated and powerless to act on this knowledge. Because of the public health emergency posed by the AIDS epidemic, the focus has been on programmatic solutions to decrease individual risk. We believe that it is time to overcome our institutional paralysis and proceed to conduct research and implement interventions that will address the contextual factors that impede further progress in HIV risk reduction.

The value of community level approaches is recognized in biomedicine as evidenced from interventions such as vaccines. It is the value of vaccines in controlling infection at the community level that drives the success of vaccine programs. Indeed, immunization programs are generally designed to maximize indirect effects on transmission. With respect to HIV, consider the community study of STD treatment in Mwanza, Tanzania. Although not directed at HIV control per se, the attention to STD control at the community level resulted in a decline in HIV rates. Population structure, social networks, and community linkages have all been successfully included as parameters in such studies.

To this end we make the following specific recommendations:

In summary, the AAA Commission on AIDS Research and Education urges that intervention research be viewed in the broadest possible context--one which includes social and community level research and intervention as well as individual behavior change.

AAA Statements
Commission on AIDS Research and Education

updated 9/15/00

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