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  1. Transition and the HIV...
  2. Transition and the HIV risk environment
Education And Debate

Transition and the HIV risk environment

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7510.220 (Published 21 July 2005) Cite this as: BMJ 2005;331:220
  1. Tim Rhodes (t.rhodes@imperial.ac.uk), researcher in public health sociology1,
  2. Milena Simic, research officer1
  1. 1 Centre for Research on Drugs and Health Behaviour, Imperial College, London W6 8RP UK
  1. Correspondence to: T Rhodes

    Social changes arising from political transition may have contributed to the spread of HIV. Successful prevention strategies require change to the risk environment as well as individual behaviour

    Introduction

    Transmission of HIV, like that of other behaviourally mediated infections, is influenced by the particular environments in which risk is produced.1 2 The spread of HIV is shaped by variations in population behaviour and public health response, which are themselves shaped by differences in social, cultural, economic, and political condition. Prevention strategies aimed at individual behaviour may therefore only partially reduce the risk of transmission.3 We also need strategies to create the local environments and social structural conditions supportive of risk reduction by individuals and communities. Transition is a form of environmental change that can disrupt individual and community level risk reduction, weakening the capacity of public health responses. We suggest the concept of risk environment as a way of analysing the effect of large scale and abrupt social, economic, and political change in eastern Europe and the western Balkans on the spread of HIV and show how it can be used to plan a response.

    What is a risk environment?

    The risk environment comprises risk factors exogenous to the individual.4 5 It takes into account both the type and the level of environmental influence (table 1). Research into prevention of HIV highlights four types of environmental influence—physical, social, economic, and policy—at two levels. The micro-risk environment focuses on personal decisions as well as the influence of community level norms and practices. The macro-risk environment seeks to capture structural factors, such as laws, military actions, economic conditions, and wider cultural beliefs.

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    Table 1

    Simple model of HIV risk environment in the context of transition5


    Embedded Image

    Making homemade opium tar into an injectable solution, Omsk, Russia

    Credit: JOHN RANARD

    Eastern Europe

    The rapid spread of HIV associated with drug …

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