Columbia University, Department of Epidemiology, Mailman School of Public Health, 710 W 168th Street, NI 614-A, New York, NY 10032, United States.
Soc Sci Med. 2012 Nov;75(9):1555-61. doi: 10.1016/j.socscimed.2012.02.016. Epub 2012 Mar 20.
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.
本文将化学预防与强调个体行为的疾病生物医学模式联系起来。我们认为，在人群层面上，化学预防艾滋病毒干预措施的效用有限，需要优先考虑结构性干预措施。我们使用最近的 CAPRISA 004 和 iPrEx 试验来：（a）通过突出疗效和效果之间的差异，从公共卫生的角度批判这些试验的效用；（b）应用健康行为的替代理论，以此将该领域重新定位为讨论需要采用结构性干预措施的必要性；（c）审查艾滋病毒预防工作的两个方面——资金结构和生物医学方法的医源性影响——以此克服更广泛采用结构性干预措施的障碍。
