Table Of ContentPreventing AIDS
Theories and Methods of
Behavioral Interventions
AIDS Prevention and Mental Health
Series Editors:
David G. Ostrow, M.D. . Ph.D. and Jeffrey A. KeUy, Ph.D.
Medical College of Wisconsin
Milwaukee, Wisconsin
Methodological Issues in AIDS Behavioral Research
Edited by David G. Ostrow, M.D., Ph.D., and Ronald C. Kessler, Ph.D.
Preventing AIDS: Theories and Methods of Behavioral Interventions
Edited by Ralph J. DiOemente, Ph.D., and John L. Peterson, Ph.D.
A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new
volume immediately upon publication. Volumes are billed only upon actual shipment. For further information
please contact the publisher.
Preventing AIDS
Theories and Methods of
Behavioral Interventions
Edited by
Ralph J. DiClemente, Ph.D.
University ofA labama
Birmingham, Alabama
and
John L. Peterson, Ph.D.
Georgia State University
Atlanta, Georgia
Foreword by
Jonathan Mann, M.D., M.P.H.
Springer Science+Business Media, LLC
Library of Congress Cataloging-in-Publication Data
Preventing AIDS : theories and methods of behavioral Interventions
edited by Ralph J. DlClenente and John L. Peterson foreword by
;
Jonathan Mann,
p. en.
Includes bibliographical references and Index.
1. HIV Infections--Prevention. 2. Health behavior
I. DlClenente, Ralph J. II. Peterson, John L.
RA644.A25P7534 1994
614.5'993--dc20 94-2857
CIP
109876543
ISBN 978-1-4899-1195-7 ISBN 978-1-4899-1193-3 (eBook)
DOI 10.1007/978-1-4899-1193-3
© Springer Science+Business Media New York 1994
Originally published by Plenum Press, New York in 1994
Softcover reprint of the hardcover 1st edition 1994
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form
or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise,
without written permission from the Publisher
Contributors
Albert Bandura • Department of Psychology, Stanford University, Stanford,
California 94305
Marshall H. Becker • Department of Health Behavior and Health Education,
School of Public Health, University of Michigan, Ann Arbor, Michigan 48109-
2029
James W. Dearing • Department of Communication, Michigan State Uni
versity, East Lansing, Michigan 48824-1212
Don C. Des Jarlais • Chemical Dependency Institute, Beth Israel Medical
Center, New York, New York 10003
Ralph J. DiClemente • School of Public Health, Department of Health Be
havior and School of Medicine, Departments of Medicine and Pediatrics, and
Center for AIDS Research, University of Alabama, Birmingham, Alabama
35294
Lynda S. Doll • Division of HIV/ AIDS, National Center for Infectious Dis
eases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333
Edward Dunne. Department of Psychiatry, College of Physicians and Sur
geons, Columbia University, New York,New York, 10032
Julie Feldman • Division of Child Psychiatry, College of Physicians and Sur
geons, Columbia University, New York, New York 10032
Martin Fishbein • Department of Psychology, University ofDlinois, Cham
paign, Illinois 61820
Samuel R. Friedman • National Development and Research Institutes, 11
Beach Street, New York, New York, 10013
Joseph Guydish • Institute for Health Policy Studies, School of Medicine,
University of California, San Francisco, San Francisco, California 94143-
0936
v
vi Contributors
Janet S. Harrison. Division ofHIV/AIDS, National Center for Infectious
Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333
Robert B. Hays. School of Medicine, University of California, San Francisco,
San Francisco, California 94143, and Center for AIDS Prevention Studies,
San Francisco, California 94105
Penelope J. Hitchcock • Sexually Transmitted Diseases Branch, National
Institute o.f Allergy and Infectious Diseases, National Institutes of Health,
Bethesda, Maryland 20892
John B. Jemmott III • Department of Psychology, Princeton University,
Princeton, New Jersey 08544
Loretta Sweet Jemmott. College of Nursing, Rutgers, The State University
of New Jersey, Newark, New Jersey 07112
Jeffrey A. Kelly • Department of Psychiatry and Mental Health Sciences,
Medical College of Wisconsin, Milwaukee, Wisconsin 53226
Douglas Kirby • ETR Associates, P.O. Box 1830, Santa Cruz, California
95061-1830
Gary Meyer. Department of Communication, Michigan State University,
East Lansing, Michigan 48824-1212
Susan E. Middlestadt • Social Development Program, Academy for Edu
cational Development, Washington, DC 20037
Janet S. Moore • Division of HIV/ AIDS, National Center for Infectious
Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333
Thomas R. O'Brien • Viral Epidemiology Section, National Cancer Institute,
Rockville, Maryland 20892
Nancy S. Padian • School of Medicine, University of California, San Fran
cisco, and San Francisco General Hospital, San Francisco, California 94110
John L. Peterson. Department of Psychology, Georgia State University, At
lanta, Georgia 30303
Laurie Roehrich • Department of Psychiatry, University of California, San
Francisco, and Substance Abuse Services, San Francisco General Hospital,
San Francisco, California 94110
Everett M. Rogers • Department of Communication and Journalism, Uni
versity of New Mexico, Albuquerque, New Mexico 87131-1171
Contributors vii
Margaret Rosario. Department of Psychiatry, College of Physicians and
Surgeons, and School of Public Health, Columbia University, New York,
New York 10032
Irwin M. Rosenstock. Department of Health Behavior and Health Educa
tion, School of Public Health, University of Michigan, Ann Arbor, Michigan
48109-2029, and College of Health and Human Services, California State
University, Long Beach, Long Beach, California 90840
Mary Jane Rotheram-Borus • Division of Social Psychiatry, Department of
Psychiatry, UCLA Neuropsychiatric Institute, Los Angeles, California 90024-
1759
James L Sorensen. Department of Psychiatry, University of California, San
Francisco, and Substance Abuse Services, San Francisco General Hospital,
San Francisco, California, 94110
Victor J. Strecher • Department of Health Behavior and Health Education,
School of Public Health, University of North Carolina at Chapel Hill, Chapel
Hill, North Carolina, 17599
Tamara L Wall. Department of Psychiatry, University of California, San
Francisco, and Substance Abuse Services, San Francisco General Hospital,
San Francisco, California 94110
Thomas P. Ward. National Development and Research Institutes, 11 Beach
Street, New York, New York 10013
John K. Watters • Department of Family and Community Medicine and
Institute for Health Policy Studies, School of Medicine, University of Cali
fornia, San Francisco, San Francisco, California 94143-1304
Janneke H. H. M. van de Wijgert. School of Medicine, University of Cal
ifornia, San Francisco, and San Francisco General Hospital, San Francisco,
California 94110
Foreword
Public health has a legacy of neglect regarding social and behavioral research.
Too often, prompted by technical and scientific progress, we have ignored
even marginalized-the vital "human element" in health thinking and prac
tice. Thus, for example, while family planning programs focused on providing
a choice among safe and effective contraceptive methods (a supremely worthy
goal), the central issue of sexuality and sexual behavior was generally neglected.
Similarly, the enormous and important efforts to develop rapid and reliable
diagnostic and treatment methods for sexually transmitted diseases helped
divert attention away from the crucial issues of sexual practice. In short, we
seem to have difficulty addressing the fundamental behaviors-including sex,
drug taking and other intoxications, and violence-that are central to the
major causes of preventable morbidity, disability, and premature mortality
in the world today.
Our collective reluctance to examine and understand ourselves is also
expressed in the oft-repeated pipedream that scientific progress will "take care
of" the HIV/ AIDS pandemic by delivering a preventive vaccine, an effective
cure, or both. Yet even a cursory glance at the relationship between scientific/
technical progress and health shows that meeting the scientific challenges is
only one step toward effective application of the vaccine or drug. It is typical,
not atypical, that hepatitis B vaccine is only now becoming relatively freely
available to large populations in the developing world, more than a decade
after the vaccine's licensure. It would be similarly naive to think that once
the vials of an effective AIDS vaccine are in hand, our only concern will be
how to make the vaccine truly available to all who need it. Simply stated,
how we use the fruits of scientific research is as "behavioral"-albeit at a
collective level-and as important in the future of the HIV/ AIDS pandemic
as the specific life activities, individually practiced, that are usually called
"behavior. "
HIV/ AIDS has helped focus attention on our relatively primitive current
capacity to describe usefully, understand, or modify effectively several basic
behaviors, at either the individual or collective level. Therefore, this fine book,
ix
x Foreword
edited by Ralph DiClemente and John Peterson, offers a useful contribution
by presenting both a range of conceptual frameworks and practical experiences
in the efforts to prevent HIV infection.
But where do we go from here? Perhaps several breakthroughs are needed.
First, we need a broad acknowledgment of the central, crucial, inextricable
interdependence between health and behavior. Second, we need to support
innovative and creative efforts to develop new conceptual frameworks where
(as is most often the case) existing concepts seem inadequate. Third, we must
be rigorously self-critical, to distinguish the workmanship-like efforts at routine
KABP (Knowledge, Attitudes, Beliefs, Practices) surveys from research that
can truly and concretely inform design and modification of prevention efforts.
Fourth, we need to build bridges between the worlds of behavioral research
and the world of public health.
Yet in the end, we will need to recognize that changing public and political
attitudes toward behavioral research is part of a larger agenda that seeks to
transform society in ways that promote health. Health, thanks to the World
Health Organization's definition, is now understood to involve physical,
mental, and social well-being. Accordingly, a society that denies its humanness,
its basic nature as a human community, a community of people, and prefers
to think in terms of social or environmental engineering or modification can
not be truly healthy. It may not be evident on a daily basis, but those working
to understand and respond to human behavior-individual and collective
are the great pioneers upon whom the future of health-and our world
may well depend.
Jonathan Mann, MD, MPH
Fram;ois-Xavier Bagnoud Professor
ofH ealth and Human Rights
Harvard School ofP ublic Health
Director, International AIDS Center,
Harvard AIDS Institute
