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Resurrecting the divide? A critique of prevention efforts targeting HIV positive populations

Vincent Del Casino, PhD, Department of Geography, California State University, Long Beach, 1250 Bellflower Blvd., Long Beach, CA 90840, 5629852357, vdelcasi@csulb.edu, Lee M. Kochems, MA, Center for Behavioral Research and Services, CSU, Long Beach, 1090 Atlantic Ave., Long Beach, CA 90813, and Dennis Fisher, PhD, Center for Behavioral Research and Services, Cal State University, Long Beach, 1090 Atlantic Ave., Long Beach, CA 90813.

Objective: We argue that targeting prevention services solely to HIV positive populations is culturally inappropriate and disempowers those at risk for new HIV infections. We offer a critique of this emerging divide in health prevention discourse by providing an alternative model of prevention that targets both HIV positive and negative populations and challenge risk-behavior-based prevention models. Methods: Ethnographic findings from three HIV risk reduction studies conducted in Long Beach, CA with drug using Gay and bisexual men inform this analysis. Data were collected through participant observation/field interviews (N = 59), a focus group (N = 6), and intensive ethnographic interviews including life histories (N = 25). These findings provide context for a meta-analytic of the broader HIV risk-reduction/prevention research. Findings: (1) The emphasis on testing and prevention with HIV positive populations shifts societal blame to this population; (2) This shift reduces HIV negative populations perceived responsibility for behavior change; (3) Points in time and space when individuals create “identity shifts” (e.g., HIV negative = not at risk = not responsible for safe sex or HIV positive = undetectable viral load = not a vector) are not targeted in interventions. Conclusion : Effective prevention requires educating HIV positive and negative populations on how to transform social and personal identities to avoid HIV. Prevention discourses need to be broadened to include both sides of the positive/negative binary. This requires re-targeting risk reduction interventions toward the underlying personal and power relations that construct social identities and tie those identities to particular risk practices.

Learning Objectives:

Keywords: HIV Interventions, Prevention

Related Web page: www.csulb.edu/~vdelcasi

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

HIV/AIDS Prevention Poster Session

The 132nd Annual Meeting (November 6-10, 2004) of APHA