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HIV and chemoprophylaxis, the importance of considering social structures alongside biomedical and behavioral intervention.

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Titre :	HIV and chemoprophylaxis, the importance of considering social structures alongside biomedical and behavioral intervention. (2012)
Auteurs :	ROBERTS (Eric-T) : USA. Columbia University. Department of Epidemiology. Mailman School of Public Health. New York. NY. ; MATTHEWS (Derrick-D) : USA. The University of North Carolina at Chapel Hill. Department of Health Behavior and Health Education. Gillings School of Global Public Health. Chapel Hill. NC.
Type de document :	Article
Dans :	Social science and medicine (vol. 75, n° 9, 2012)
Pagination :	1555-1561
Langues:	Anglais
Mots-clés :	Sida ; VIH ; Chimioprophylaxie ; Prévention santé ; Structure sociale ; Biologie ; Comportement ; Essai préventif ; Essai thérapeutique ; Randomisation ; Surveillance ; Homme ; Virose ; Infection ; Rétrovirus ; Virus ; Immunopathologie
Résumé :	[BDSP. Notice produite par INIST-CNRS BltR0xJE. Diffusion soumise à autorisation]. 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.