Shari L. Dworkin

Structural Interventions: Concepts, Challenges and Opportunities for Research

Structural interventions refer to public health interventions that promote health by altering the structural context within which health is produced and reproduced. They draw on concepts from multiple disciplines, including public health, psychiatry, and psychology, in which attention to interventions is common, and sociology and political economy, where structure is a familiar, if contested, concept. This has meant that even as discussions of structural interventions bring together researchers from various fields, they can get stalled in debates over definitions. In this paper, we seek to move these discussions forward by highlighting a number of critical issues raised by structural interventions, and the subsequent implications of these for research.

Rethinking Gender, Heterosexual Men, and Women's Vulnerability to HIV/AIDS

Most HIV prevention literature portrays women as especially vulnerable to HIV infection because of biological susceptibility and mens sexual power and privilege. Conversely, heterosexual men are perceived as active transmitters of HIV but not active agents in prevention. Although the womens vulnerability paradigm was a radical revision of earlier views of women in the epidemic, mounting challenges undermine its current usefulness. We review the etiology and successes of the paradigm as well as its accruing limitations. We also call for an expanded model that acknowledges biology, gender inequality, and gendered power relations but also directly examines social structure, gender, and HIV risk for heterosexual women and men.

Sample Size Policy for Qualitative Studies Using In-Depth Interviews

In recent years, there has been an increase in submissions to theJournal that draw on qualitative research methods. This increaseis welcome and indicates not only the interdisciplinarityembraced by the Journal(Zucker, 2002)butalsoits commitmenttoawidearrayofmethodologies.Forthosewhodoselectqualitativemethodsandusegroundedtheory and in-depth interviews in particular, there appear to be alotofquestionsthatauthorshav ehadrecentlyabouthowtowritea rigorous Method section. This topic will be addressed in a sub-sequentEditorial.Atthistime,however,themostcommonques-tion we receive is:‘‘How large does my sample size have to be?’’and hence I would like to take th is opportunity to answer thisquestionbydiscussingrelevantdebatesandthenthepolicyoftheArchivesofSexualBehavior.

Gender-Transformative Interventions to Reduce HIV Risks and Violence with Heterosexually-Active Men: A Review of the Global Evidence

Emerging out of increased attention to gender equality within HIV and violence prevention programming has been an intensified focus on masculinities. A new generation of health interventions has attempted to shift norms of masculinity to be more gender equitable and has been termed “gender-transformative.” We carried out a systematic review of gender-transformative HIV and violence prevention programs with heterosexually-active men in order to assess the efficacy of this programming. After reviewing over 2,500 abstracts in a systematic search, a total of 15 articles matched review criteria. The evidence suggests that gender-transformative interventions can increase protective sexual behaviors, prevent partner violence, modify inequitable attitudes, and reduce STI/HIV, though further trials are warranted, particularly in establishing STI/HIV impacts. In the conclusion, we discuss the promises and limitations of gender-transformative work with men and make suggestions for future research focused on HIV and/or violence prevention.

Microfinance and HIV/AIDS Prevention: Assessing its Promise and Limitations

Researchers increasingly argue that poverty and gender inequality exacerbate the spread of HIV/AIDS and that economic empowerment can therefore assist in the prevention and mitigation of the disease, particularly for women. This paper critically evaluates such claims. First, we examine the promises and limits of integrated HIV/AIDS prevention and microfinance programs by examining the available evidence base. We then propose future research agendas and next steps that may help to clear current ambiguities about the potential for economic programs to contribute to HIV/AIDS risk reduction efforts.

Who is epidemiologically fathomable in the HIV / AIDS epidemic? Gender sexuality and intersectionality in public health.

This paper examines the shifting nature of contemporary epidemiological classifications in the HIV/AIDS epidemic. It first looks at assumptions that guide a discourse of vulnerability and circulate around risk categories. It then examines the underlying emphasis in public health on the popular frame of “vulnerable women” who acquire HIV through heterosexual transmission. Drawing on work on gender, sexuality, and intersectionality, the paper asks why a discourse of vulnerability is infused into discussions of heterosexually‐active womens HIV risks but not those pertaining to heterosexually‐active mens. The paper then moves to current surveillance categories that are hierarchically and differentially applied to womens and mens risks in the HIV epidemic. Here, the focus is on the way in which contemporary classifications allow for the emergence of the vulnerable heterosexually‐active woman while simultaneously constituting lack of fathomability concerning bisexual and lesbian transmission risk. Lastly, theories of intersectionality, are used to examine current research on woman‐to‐woman transmission, and to suggest future more productive options.

Actual versus desired initiation patterns among a sample of college men: Tapping disjunctures within traditional male sexual scripts

Research on mens sexual scripts has tended to overlook that some men do not endorse traditional scripts or that one or both members of a couple might desire a departure from culturally dominant sexual scripts. This study used in‐depth interviews with 32 college‐aged men from a community college in New York City to examine disjunctures between current and desired sexual initiation patterns. Results show that although most men currently practice male‐dominated patterns of sexual initiation, many men desire egalitarian patterns of initiation. Men offered clear preference to be an object of desire to their female partners, deployed narratives of wanting to share the “labor” of sexual initiation, and expressed ideologies of sexual egalitarianism. We consider how shifting terrains of gender relations in contemporary U.S. culture may shape masculinities and sexual scripts. We also consider how an examination of disjunctures between current and desired practices might be useful to HIV researchers interested in intervening across multiple levels of the sexual script.

Male circumcision and HIV/AIDS: challenges and opportunities

2enrolled in the respective studies. The Kenya and Uganda trials replicated the landmark fi ndings of the South African Orange Farm study, the fi rst randomised controlled trial to report a greater than 50% protective benefi t of male circumcision. 3 Before the availability of data from these three African randomised controlled trials, multiple observational studies correlated male circumcision with reduced risk of HIV infection. 4–9 Systematic reviews and meta-analysis of observational studies provide further evidence of the association of male circumcision with reduced risk of HIV infection 10–12 and a plausible explanation for the biological mechanism for reduced risk of infection has been suggested. 13 Recently released longitudinal evidence of the range of health benefi ts that male circumcision provides, 14

“Getting your Body Back”: Postindustrial Fit Motherhood in Shape Fit Pregnancy Magazine

This investigation explores how contemporary (corporeal) motherhood is constituted in postindustrial consumer culture through a content and textual analysis of Shape Fit Pregnancy. Using all available issues of the magazine from its inception in 1997 to 2003, the authors first underscore a key tension surrounding pregnant women’s bodies within health and fitness discourse: That the pregnant form is presented as maternally successful yet aesthetically problematic. Second, the authors reveal how contemporary mothers are defined as newly responsible for a second shift of household labor and child care and a new third shift of bodily labor and fitness practices. The analysis examines the way in which the second and third shift are constituted as mutually dependent and reinforcing. Last, the discussion analyzes how this particular fitness text draws on empowerment discourse derived from feminist gains of access to the public sphere while paradoxically (re)inscribing women to the privatized realm of bodily practices, domesticity, and family values.

Keeping the Spirit of Community Partnerships Alive in the Scale Up of HIV/AIDS Prevention: Critical Reflections on the Roll Out of DEBI (Diffusion of Effective Behavioral Interventions)

DEBI, or the Diffusion of Effective Behavioral Interventions is the largest centralized effort to diffuse evidence-based prevention science to fight HIV/AIDS in the United States. DEBI seeks to ensure that the most effective science-based prevention interventions are widely implemented across the country in community-based organizations. Thus, this is a particularly timely juncture in which to critically reflect on the extent to which known principles of community collaboration have guided key processes associated with the DEBI rollout. We review the available evidence on how the dissemination of packaged interventions is necessary but not sufficient for ensuring the success of technology transfer. We consider additional principles that are vital for successful technology transfer, which were not central considerations in the rollout of the DEBI initiative. These issues are: (1) community perceptions of a top-down mode of dissemination; (2) the extent to which local innovations are being embraced, bolstered, or eliminated; and (3) contextual and methodological considerations that shape community preparedness. Consideration of these additional factors is necessary in order to effectively document, manage, and advance the science of dissemination and technology transfer in centralized prevention efforts within and outside of HIV/AIDS.