Amsterdam 2015
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| Abstract #2389 - Martin Fishbein Memorial Plenary | ||||
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Session: 1.1: Martin Fishbein Memorial Plenary (Plenary) on Tuesday @ 12.30-14.30 in C103 Chaired by Kees Rietmeijer, Barbara Hedge, Kevin Malotte Authors: Presenting Author: Professor William Darrow - Florida International University, United States |
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| Additional Authors: | ||||
| Aim: Any behavioral scientist working in the field of HIV prevention for any appreciable period has to admire the resilience of the biomedical model. Social, cultural, economic, political, and psychological phenomena that interact in complex ways to produce and sustain disease transmission are distilled in the biomedical model to just three essential components: human host, physical environment, and disease-causing pathogen and, of course, the connections that unite them. All you need to do to stop transmission is simply break the link between pathogen and host. Nothing else matters. | ||||
| Method / Issue: Else mattered to George Engle (1977) when he pointed out several limitations of the biomedical model and suggested a biopsychosocial model instead. Public health research being conducted at the time—not in laboratories, but in communities—was suggesting that cigarette smoking “causes” lung cancer, a sedentary lifestyle “causes” cardiovascular disease, and “the 3 P’s” (“permissiveness, promiscuity, and ‘the pill’”) "cause” sexually transmitted diseases (STD). Models for preventing these conditions required that the concept of environment be expanded to include social and cultural dimensions and consideration be given to the determinants of harmful behaviors. | ||||
| Results / Comments: As the AIDS Community Demonstration Projects (ACDP) were being conceived, an ecological model for health promotion was formulated by McLeroy et al. (1988) that identified opportunities for behavior change at five distinct levels: intrapersonal, interpersonal, institutional, community, and societal. This alternative to the biomedical model of infectious disease control offered a range of strategies that could—and should—be designed to modify damaging lifestyles through social as well as individual behavior change. Furthermore, comprehensive health promotion programs could be developed and implemented that combined appropriate interventions at all five levels to maximize favorable outcomes. By 1991 Fishbein and colleagues were convinced that “primary prevention must focus upon behavior and behavior change” and “the task confronting the behavioral sciences is thus to develop programs to reduce ‘risky’ and increase ‘healthy’ behaviors.” After considering five psychosocial theories, Fishbein et al. identified a set of eight critical variables for promoting behavior change, especially, a strong positive intention, no environmental constraints, and necessary performance skills. Without a vaccine and chemoprophylaxis, the US Centers for Disease Control and Prevention supported ACDP implementation to determine if theoretically justified behavioral interventions could increase the use of condoms and bleach to prevent HIV transmission among populations at increased risk. Results were promising, but the “demos” were unsustainable. | ||||
| Discussion: Reflecting on the history of AIDS, Valdiserri (2013) attributes the 20-year failure to reduce the annual incidence of HIV infections in the US to gaps in knowledge, especially in the domains of vaccines and microbicides, and to failures to bring proven interventions to scale. He admits, “Biomedical approaches, by themselves, may not be adequate to reduce HIV incidence.” “Given that HIV/AIDS is first and foremost a ‘social disease,’ involving social and political researchers in the mix of experts…will certainly improve the quality of outcomes.” Research currently being conducted in the US is confirming Valdiserri’s suspicions and I am wondering why Public Health experts are still clinging to the biomedical model. | ||||
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