BIOMEDICAL AND SOCIAL DIMENSIONS OF HIV PREVENTION/KIPPAX AND STEPHENSON RESPOND

What is needed is a focus on prevention programs and the use of a complex adaptive-systems approach in analyzing context, interventions, and the resulting interactions.5,6 The emerging view is that populations that are the focus of prevention efforts constitute complex adaptive systems with distinct characteristics and that the effectiveness of prevention can only be defined as a function of the interaction between the preventive intervention mix and the population context. About the Authors Sevgi O. Aral is with the Division of STD Prevention, The National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. Furthermore, as Aral and Blanchard point out, biomedicalized prevention focuses on identifying universalizable "interventions" (mistakenly thought to be assessable via randomized control trials) rather than developing whole prevention programs (evaluated over time by surveillance and monitoring systems and process evaluations) designed to address the complexity of HIV prevention.\n4(p157) To this we want to add that choosing and implementing the right strategy for particular populations or subpopulations requires more than program science expertise-no matter how expert.