Hirsch Jennifer S
Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
AIDS. 2007 Oct;21 Suppl 5:S21-9. doi: 10.1097/01.aids.0000298099.48990.99.
To explore how, within the context of antiretroviral therapy (ART) uptake and adherence, social science research on gender and sexuality could complement existing epidemiological and behavioral research on uptake, adherence, disinhibition and reproduction.
Bibliographical database searches on ART uptake and adherence, the sexual practices of HIV-positive individuals, and fertility management among HIV-positive men and women were conducted over a 6-month period using ISI Web of Science and Medline. Articles were sorted by main topic and then analysed to reveal the unarticulated assumptions that have framed research to date.
The adoption of more social scientific theoretical frameworks would move research on uptake, adherence, disinhibition, and reproduction among HIV-infected and affected individuals beyond the current overemphasis on how cognitive and ideological factors shape behavior and towards an understanding of how culture and inequality shapes the way people engage with ART and craft their sexual and reproductive lives. Research that pays greater attention to the social processes that create differentials in uptake and adherence, rather than just the quantification of those differentials, will open up new possibilities for community-based interventions. Similarly, social science research on gender and sexuality can provide insight into the social factors shaping reproductive and sexual behavior, and thus enhance our ability to manage the potentially competing priorities of limiting marital sexual risk and increasing access to reproductive choice among HIV-affected couples.
The ability to produce good clinical outcomes and to develop effective policies for secondary prevention will be enhanced by a deeper understanding of how gender inequality and the social organization of sexuality shape the sexual and reproductive behavior of individuals using ART.
探讨在抗逆转录病毒疗法（ART）的接受与依从背景下，关于性别与性取向的社会科学研究如何补充现有的关于接受、依从、抑制解除及生殖方面的流行病学和行为学研究。
在6个月的时间里，使用科学网（ISI Web of Science）和医学期刊数据库（Medline）对有关ART的接受与依从、HIV阳性个体的性行为以及HIV阳性男性和女性的生育管理进行书目数据库检索。文章按主要主题分类，然后进行分析，以揭示迄今为止构成研究框架的未阐明假设。
采用更多社会科学理论框架将推动对HIV感染及受影响个体在接受、依从、抑制解除和生殖方面的研究，使其超越当前对认知和意识形态因素如何塑造行为的过度强调，转向理解文化和不平等如何塑造人们接受ART以及规划其性和生殖生活的方式。更加关注造成接受和依从差异的社会过程而非仅仅对这些差异进行量化的研究，将为基于社区的干预开辟新的可能性。同样，关于性别与性取向的社会科学研究可以深入了解塑造生殖和性行为的社会因素，从而增强我们管理限制婚姻性风险和增加受HIV影响夫妇获得生殖选择这两个潜在相互竞争的优先事项的能力。
通过更深入地理解性别不平等和性取向的社会组织如何塑造使用ART的个体的性和生殖行为，将提高产生良好临床结果以及制定二级预防有效政策的能力。
