Sunday, November 23, 2008

            >> Sounds like it would work well for some folks, not so well for a hookup.

    Gosh, I'm just thinkin out loud here, but could "hookups" have anything to do with the AIDS epidemic?

    > I was pointing out that there are common situations in the real world where the strategy you're touting wouldn't be especially helpful.

Not washing hands before operating was also once a very common strategy--even a standard practice.

    > Do hookups have something to do with the AIDS endemic? I suppose you could look at it that way.

I'm going out on a limb here, but will guess yes.

    > The broader question I'm asking is whether it is helpful to look at AIDS as the sum of behaviors and biologic test results (as current epidemiology & public health practice tend to do), or whether it might make sense to back off a bit and ask whether we might make more of a difference by laying off the moralism inherent in behavioral approaches

I'm going out on a limb here, but will guess that things like clean water, sterilized instruments, and washed hands have little to do with moralism.

    > and focusing on some of the structural forces, such as homophobia, gender hierarchies, racist ideologies, and poverty production that also obviously have huge impacts on the AIDS endemics across the world.

I'm guessing that some of the stanard practices mentioned above would work for homophobes, non-homophobes, racists, non-rascits, poor or rich people, etc, all over the world.

            >> I guess what I'm trying to figure out is how people react to the concept of risk,

Irrationally is the word I think you're looking for.

            >> and whether 'public health' might not better be focused on some of its more traditional success strategies that involve systemic changes, rather than individual coaching.

I'm thinking that people become infected one at a time.

    With something like tuberculosis the FIRST step is to get tested. Workin out pretty good so far...

            >> ...Traditionally, public health has had its greatest success{es} with things like water, sewage, & poverty remediation.

    and testing...

Individuals have to take care of the testing part.

    > Tuberculosis is a great example of how structural changes far outstripped the ability of medicine and individualized behavioral messages to curtail the spread.

Today everybody deals with it, first, by testing.

    > Arguably, the first successful steps in curtailing the spread of tuberculosis included addressing slum dwellings where people lived in extremely close quarters, pasteurization of milk, and various other public health approaches. (e.g. AJPH 1998 88(7):1105-1117)

Its still time for individuals to get tested...

A L Fairchild and G M Oppenheimer
Public health nihilism vs pragmatism: history, politics, and the control of tuberculosis

    > Testing in NYC began in the late 1880's, well after tuberculosis incidence had started declining rapidly. It probably helped somewhat after that point, but we have tended to overlook the relatively larger impacts of structural interventions that preceeded testing and continued to affect the incidence of tuberculosis afterwards as well.

Once all the reading is finished you still need to go get tested.

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