Al nations, such as Brazil and Thailand,7—9 and from cities for instance New York City; Rotterdam, the Netherlands; and Buenos Aires, Argentina and internet sites in Central Asia.10 A lot of of those studies supply rich and detailed accounts of your social and political processes involved within the collective shifts in social practices that preceded declining HIV incidence, plus the role of sexual communities, kinship networks, and drug making use of groups in achieving these outcomes. Though the evidence for effectiveness isn’t conclusive (and effectiveness can’t be assessed the identical way as efficacy making use of randomized controlled trials or other forms of experimental handle),11 proof is available. Such evidence, framed as a series of methods from HIV prevalence to national policies via measures of HIV incidence, alterations in behavior, and HIV prevention programs,12 indicates much more or much less what has worked in unique settings at particular times. It really is clear that collectives, whether or not they may be communities, networks, or groups, are central in terms of advocating, initiating, and implementing modify. Having said that, what is not clearly stated is how communities become transformative in their practices. Following Adam’s analysis13 of your techniques in which the epistemological framework, which can be characteristic of biomedical individualism, bypasses the social, we aim to show how the predominant approaches of framing discussion of HIV prevention, with regards to threat or vulnerability, have occluded attempts to know how social transformation occurs. We also examine how the idea of “social drivers” attempts to offer the conceptual tools for engaging with community responses to HIV. Even though such framing doesn’t rather fulfill its guarantee, it points toward a potentially productive way of understanding social transformation and adjust. We examine the centrality of collective agency and social practice in social transformation, drawing on examples of shifts in practice in 2 contrasting countries, Australia and Brazil. These casesAugust 2013, Vol 103, No. 8 | American Journal of Public HealthKippax et al. | Peer Reviewed | Framing Overall health Matters |FRAMING Wellness MATTERSdemonstrate public health’s capacity to engage with collective agency when it Squalamine site requires as its starting point neither danger nor vulnerability, however the collective agency of communities whose HIV prevention efforts are shaped by the specificities of what they worth.RISKThe notion of risk drove considerably early HIV prevention investigation and remains a crucial analytical device. The majority of HIV prevention efforts have been focused around the risk behaviors of individuals constituting populations at threat (e.g., unprotected sexual intercourse, sharing of injecting equipment). Such efforts have focused on modifying the threat behaviors of people, exactly where individuals are generally viewed as neoliberal rational agents, who need to and would transform their behavior if they have been offered facts concerning the risk of HIV transmission, how to stop it, and had access to HIV-prevention tools, for example condoms and sterile needles and syringes. From this point of view, people engaging in risk behavior are either uninformed or ill-informed, are subject to outdoors stress, or are behaving irrationally.14 The theories underpinning HIV prevention that focus on risk are largely derived from psychological models, in which the rational self-efficacious person is center stage, and behavior alter is understood to be a function of an individual’s a.