AIDS: Challenges to Epidemiology in the 1990s

Abstract

The author begins by describing the various 'stages' of epidemiological thinking on AIDS since the beginning of the epidemic, and the shortcomings of each. He suggests that epidemiology is currently in need of an additional transition in order to fill "a critical gap...between what has been measured regarding sexual behavior and what knowledge is needed to design effective behavior-based interventions to prevent sexual transmission of HIV" (p. 12). The reason for this gap, the author suggests, is the overly "deterministic" and "individualistic" models employed by epidemiologists to understand the determinants of sexual decision-making and behavior. Such approaches decontextualize sexual behavior from its sociological, economic, and psychological contexts, and ignores the "intuitively felt realities of sexual behavior" (p. 13). He concludes that "it is clear that multidisciplinary approaches uniting epidemiology with other social sciences may be the most important next phase of development in the science of AIDS research" (p. 12). He concludes that this is the next great challenge to "behavioral epidemiology" (p. 14).