The Context of HIV Risk Among Drug Users and Their Sexual Partners

conversion and perhaps even seroconversion occur pari passu among all
who are exposed (Brunswick et al., forthcoming).
It is easier to give lip service to the social nature of the disease and to the
need for incorporating different social levels into its analysis than to do
so. The most frequently tested research model in AIDS prevention
research is the health belief model (HBM). Yet the HBM is of
questionable validity when applied to IDU and minority populations
because of its predominantly cognitive dimensions of cost-benefit and
vulnerability appraisals, behavioral and outcome efficacy, and because
the model operates primarily if not solely in the ontogenic (within the
individual) sphere (Brunswick and Banaszak-Holl, unpublished data). A
major architect of the HBM movement recently has critiqued the current
health promotion movement in words that are equally applicable to the
neglect of the social context in HIV research, policy, and programs:
Finally, I turn to what, in my estimation, is the most disturbing aspect
of the contemporary health promotion movement: its tendency to
locate the responsibility for the cause and the cure of health problems
in the individual. Three assumptions appear to underlie this
approach: personal health-related behaviors are discrete and
independently modifiable; anyone can decide to alter his/her behavior
and then go on to do so successfully; and everyone has a personal
responsibility to ‘live well’ through self-discipline and behavior
modification.... These assumptions do not fit very well with what we
know about the major determinants of health and the prevention of
illness.
I would argue, first, that health habits are acquired within social
groups (i.e., family, peers, the subculture).... The lifestyle approach
enables us to ignore the more difficult, but at least equally important,
problem of the social environment which both creates some lifestyles
and inhibits the initiation and/or maintenance of others (Becker 1993,
p. 3-4).
The three areas identified in this chapter’s title are discussed in the
remainder of the chapter: substantive, technical, and statistical issues that
might be helpful in rethinking existing research models and methods for
studying HIV. They are guided by the ecological model and concern for
situational and environmental factors that have been articulated above.
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