title: HIV and chemoprophylaxis, the importance of considering social structures alongside biomedical and behavioral intervention.
abstract: 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.
authors.affiliation: Columbia University, Department of Epidemiology, Mailman School of Public Health, 710 W 168th Street, NI 614-A, New York, NY 10032, United States. etr2113@columbia.edu
authors.forename: Eric T
authors.initials: ET
authors.lastname: Roberts
authors.forename: Derrick D
authors.initials: DD
authors.lastname: Matthews
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D018890:Chemoprevention; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008954:Models, Biological; D015397:Program Evaluation; D011582:Psychological Theory; D015980:Public Health Practice; D016032:Randomized Controlled Trials as Topic
chemical_list: D000998:Antiviral Agents