Sterk Claire E, Elifson Kirk W, Theall Katherine P
Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
Am J Prev Med. 2007 Jun;32(6 Suppl):S177-81. doi: 10.1016/j.amepre.2007.02.020.
HIV risk-reduction efforts have traditionally focused on the individual. The need for including the role of the social context and community is being recognized. Social capital provides social relationships and potential resources that may hinder or trigger risk or protective health behaviors, especially for individuals with limited economic means.
Sixty-five adult inner-city female drug users, who were included in a woman-focused HIV risk-reduction intervention trial, participated in in-depth interviews in Atlanta, Georgia, between 2002 and 2004. The interviews focused on the women's individual behavioral changes during the 6 months since completion of the intervention as well as on the impact of community conditions. Topics discussed were sexual and drug use behaviors, social relationships, social capital, and community physical and social infrastructure. The data were analyzed using the constant comparison methods.
The respondents indicated that poor physical and social infrastructure led to alienation and negatively affected their behavioral change efforts. Social capital and social support mediated these negative influences. Drug-related violence was especially debilitating in their efforts to reduce HIV risk associated with crack cocaine or injection drug use and associated sexual behavior. Environmental conditions and opportunity structures played salient roles in the women's success.
Individual actions and community context must be considered simultaneously when facilitating and assessing behavioral interventions.
传统上，降低艾滋病病毒风险的努力主要集中在个体层面。如今，人们逐渐认识到需要考虑社会环境和社区所发挥的作用。社会资本提供了社会关系和潜在资源，这些可能会阻碍或引发风险行为或保护性健康行为，对于经济手段有限的个体而言尤为如此。
65名成年市中心女性吸毒者参与了一项以女性为重点的降低艾滋病病毒风险干预试验，并于2002年至2004年期间在佐治亚州亚特兰大市接受了深入访谈。访谈聚焦于这些女性在干预结束后的6个月内的个人行为变化以及社区状况的影响。讨论的主题包括性行为和吸毒行为、社会关系、社会资本以及社区的物质和社会基础设施。采用持续比较法对数据进行分析。
受访者表示，恶劣的物质和社会基础设施导致疏离感，并对她们的行为改变努力产生负面影响。社会资本和社会支持对这些负面影响起到了调节作用。与毒品相关的暴力行为尤其削弱了她们降低与快克可卡因或注射吸毒及相关性行为有关的艾滋病病毒风险的努力。环境条件和机会结构在这些女性的成功中发挥了显著作用。
在促进和评估行为干预措施时，必须同时考虑个体行为和社区环境。
