This chapter discusses the general principles of disease prevention and their application to HIV/AIDS. The key point that is made early in the chapter is that changing an individual’s knowledge about HIV/AIDS does not automatically translate into a change in attitude or intentions or, most importantly, a change in behavior. This situation is not any different from other diseases for which people who clearly understand a health risk and the means of prevention still are resistant to change.
To explain the resistance of people to change that would improve their health or prevent them from getting sick, three models of health behavior change are considered. The first is the health belief model, which was developed from studies aimed at understanding the reasons why people do not take action to prevent asymptomatic disease. (In this context, asymptomatic diseases are diseases such as lung cancer that do not cause clinical symptoms until it is too late too treat them.) It identifies three factors that explain the failure to act to prevent risk. The first is the person’s perceived susceptibility to a health threat; the second, his or her assessment of the severity of the risk; and the third is the person’s evaluation of the effectiveness of the health-promoting or illness-preventing action. Each of these variables is clearly illustrated by specific examples germane to HIV/AIDS.
The second model is the health decision model, which is a more recent refinement of the health belief model. It acknowledges that additional factors involving social interactions also contribute to choices of behavior. These include past experiences with people important to us, the influence of others’ views and opinions, and our current interactions with others. A cogent example that is given is the manner in which condoms are viewed in a negative context in the Hispanic community because of negative associations (the Catholic church is against them; prostitutes are associated with them).
The third model is the Precaution-Adoption Process model, which differs from the two previous models in that it focuses on the process of change. The model emphasizes that decision-making often does not involve a linear series of logical steps but is more dynamic and fluid with different factors coming into play at different times. The model proposes five stages of deciding to take action that are clearly described in the text. Seven principles (cognitive, emotional, behavioral, interpersonal, social, ecological, and scientific) emerging from these models are discussed in detail in subsequent sections.
The chapter ends with two examples of successful HIV/AIDS prevention programs, one for gay and bisexual men, the other for Mexican migrant workers. Materials used in the latter program are illustrated in Figures 9-1 and 9-2. In both cases, the target behavior advocated was condom use during sex. The interventions are discussed in the context of the principles expounded earlier in the chapter.
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