Theory, measurement and hard times: some issues for HIV/AIDS research

Abstract

Economic and political instability and related "big events" are widespread throughout the globe. Although they sometimes lead to epidemic HIV outbreaks, sometimes they do not-and we do not understand why. Current behavioural theories do not adequately address these processes, and thus cannot provide optimal guidance for effective intervention. Based in part on a critique of our prior "pathways" model of big events, we suggest that cultural-historical activity theory (CHAT) may provide a useful framework for HIV research in this area. Using CHAT concepts, we also suggest a number of areas in which new measures should be developed to make such research possible.

Figure 1

Historically-situated pathways through which Big Events may sometimes unleash HIV epidemics and other harms*, ** *In some cases, such as with normative regulation and the organization of gender and sexuality, and as with corruption and insecurity (fear for one’s personal safety), variables that fit together in homologous places in the system of arrows (pathways) have been grouped together so the model remains readable. **This is reprinted from Friedman, Rossi & Braine (2009). We have not updated it but rather treat it as a historical document to be discussed and criticized in the text of this paper.

Figure 2

Figure 2a. Vygotskian model of tool-mediated action Figure 2b. Engeström’s “Activity System” Note that the Vygotsky triangle from Figure 2a is the top part of this diagram. Figure 2c. Stetsenko’s CHAT model of interrelated non-linear, overlapping and often-contradictory processes.

Figure 3

CHAT in the context of Big Events and in terms of how CHAT processes get embodied in the context of the HIV epidemic As discussed in the text, our group is developing measures for intersubjective exchanges, activities, and self as a subjective process.