The Behavior Analyst

, Volume 17, Issue 2, pp 353–363 | Cite as

A Contextual Approach to Research on AIDS Prevention

  • Edelgard Wulfert
  • Anthony Biglan


The acquired immune deficiency syndrome (AIDS) is a disease that is transmitted almost entirely through behavioral factors. In the absence of a cure or vaccine, the modification of AIDS-risk behavior presents a unique challenge to behavioral scientists and should be taken as a clear imperative by behavior analysts. This paper discusses the currently dominant social-cognitive theories (the health belief model, the theory of reasoned action, and self-efficacy theory) that have been widely used to predict and understand AIDS-risk behavior. Although these theories have generated a voluminous literature on the cognitive, attitudinal, and demographic correlates of AIDS-risk behavior, they have not resulted in specific intervention strategies to influence risky behavior, most likely because they fail to specify manipulable variables. As an alternative to social-cognitive theories, this paper evaluates the usefulness of a behavior-analytic approach to stem the spread of HIV infection. It examines some of the philosophical differences underlying cognitive and behavioral approaches that are embedded in mechanistic versus functional contextualistic principles. It explores the theoretical and practical implications of adopting either predicting and explaining behavior or predicting and influencing behavior as the goals of science. To illustrate the value of adopting the goal of prediction and influence, behavior-analytic research on the social context of risky sexual behavior in adolescents is described. The paper argues that in order to alter the future course of the AIDS epidemic, the behavioral sciences must move beyond describing cognitive and attitudinal correlates of risky behavior and focus on the social context of the behavior of individuals. In addition, population-wide changes in AIDS-risk behavior can be accomplished only if research focuses on how to influence larger social systems, including the media, school systems, and community organizations.

Key words

acquired immune deficiency syndrome (AIDS) functional contextualism health belief model self-efficacy theory theory of reasoned action 


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  1. Ajzen, I. (1988). Attitudes, behavior and personality. Chicago: The Dorsey Press.Google Scholar
  2. Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  3. Bandura, A. (1990). Perceived self-efficacy in the exercise of control over AIDS infection. Evaluation and Program Planning, 13, 9–17.CrossRefGoogle Scholar
  4. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  5. Bacchetti, P. (1990). Estimating the incubation period of AIDS by comparing population infection and diagnosis patterns. Journal of the American Statistical Association, 85, 1002–1008.CrossRefGoogle Scholar
  6. Becker, M. H. (1974). The health belief model and personal health behavior. Health Education Monograph, 2, 220–243.CrossRefGoogle Scholar
  7. Becker, W. C. (1986). Applied psychology for teachers. Chicago: Science Research Associates.Google Scholar
  8. Biglan, A. (1992). Family practices and the larger social context. New Zealand Journal of Psychology, 21, 37–43.Google Scholar
  9. Biglan, A. (1993). Recapturing Skinner’s legacy to behavior therapy. The Behavior Therapist, 16, 3–5.Google Scholar
  10. Biglan, A., Glasgow, R. E., & Singer, G. (1990). The need for a science of larger social units: A contextual approach. Behavior Therapy, 21, 195–215.CrossRefGoogle Scholar
  11. Biglan, A., & Hayes, S. C. (1993). Should the behavioral sciences become more pragmatic? The case for functional contextualism in research on human behavior. Unpublished manuscript. Eugene: Oregon Research Institute.Google Scholar
  12. Biglan, A., Noell, J., Ochs, L., Smolkowski, K., & Metzler, C. W. (1993). Does sexual coercion play a role in the high-risk sexual behavior of adolescent women? Manuscript submitted for publication.Google Scholar
  13. Bracht, N. (Ed.). (1990). Health promotion at the community level. Newbury Park, CA: Sage Publications.Google Scholar
  14. Brown, L. K., DiClemente, R. J., & Reynolds, L. A. (1991). HIV prevention for adolescents: Utility of the health belief model. AIDS Education and Prevention, 3, 50–59.PubMedGoogle Scholar
  15. Budd, R. J., North, D., & Spencer, C. (1985). Understanding seat belt use: A test of Bentler and Speckart’s extension of the theory of reasoned action. European Journal of Social Psychology, 14, 69–78.CrossRefGoogle Scholar
  16. Bullis, M., & Walker, H. M. (1993). Characteristics, causal factors, and school-based interventions for children and adolescents with antisocial behavioral disorders. In L. Meyer (Ed.), Issues and research in special education (Vol. 3). New York: Teachers College Press.Google Scholar
  17. Carmel, S. (1990/1991). The health belief model in the research of AIDS-related preventive behavior. Public Health Reviews, 18, 73–85.PubMedGoogle Scholar
  18. Catania, J. A., Coates, T. J., Stall, R., Turner, H., et al. (1992). Prevalence of AIDS-related risk factors and condom use in the United States. Science, 258, 1101–1106.CrossRefPubMedGoogle Scholar
  19. Centers for Disease Control. (1981). Kaposi’s sarcoma and Pneumocystis pneumonia among homosexual men—New York City and California. Mobidity and Mortality Weekly Reports, 30, 305–308.Google Scholar
  20. Centers for Disease Control. (1983). Acquired immunodeficiency syndrome (AIDS) update—United States. Morbidity and Mortality Weekly Reports, 32, 309–311.Google Scholar
  21. Centers for Disease Control. (1993). HIV/AIDS surveillance report, 5(2). Atlanta, GA: Author.Google Scholar
  22. Coates, T. J., Stall, R., Mandel, J. S., Boccellari, A., Sorenson, J. L., Morales, E. F., Morin, S. F., Wiley, J. A., & McKusick, L. (1987). AIDS: A psychological research agenda. Annals of Behavioral Medicine, 9, 21–28.CrossRefGoogle Scholar
  23. Cochran, S. D., Mays, V. M., Ciarletta, J., Caruso, C., & Mallon, D. (1992). Efficacy of the theory of reasoned action in predicting AIDS-related sexual risk reduction among gay men. Journal of Applied Social Psychology, 22, 1481–1501.CrossRefGoogle Scholar
  24. Coie, J. D., Watt, N. F., West, S. G., Hawkins, J. D., Asarnow, J. R., Markman, H. J., Ramey, S. L., Shure, M. B., & Long, B. (1993). The science of prevention: A conceptual framework and some directions for a national research program. American Psychologist, 48, 1013–1022.CrossRefPubMedGoogle Scholar
  25. Des Jarlais, D. C., & Friedman, S. R. (1988). The psychology of preventing AIDS among intravenous drug users: A social learning conceptualization. American Psychologist, 43, 865–870.CrossRefPubMedGoogle Scholar
  26. Dishion, T. J., Patterson, G. R., & Reid, J. B. (1988). Parent and peer factors associated with drug sampling in early adolescence: Implications for treatment. In E. Randert (Ed.), Adolescent drug abuse: Analyses of treatment research (pp. 69–93). NIDA Research Monograph 77, Washington, DC: DDHHS.Google Scholar
  27. Ecklein, J. (Ed.). (1984). Community organizers. New York: Wiley.Google Scholar
  28. Ekstrand, M. L., & Coates, T. J. (1990). Maintenance of safer sexual behaviors and predictors of risky sex: The San Francisco men’s health study. American Journal of Public Health, 80, 972–977.CrossRefGoogle Scholar
  29. Festinger, L. (1972). An introduction to the theory of dissonance. In E. P. Hollander & R. G. Hunt (Eds.), Classic contributions to social psychology (pp. 209–219). New York: Oxford University Press.Google Scholar
  30. Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention, and behavior: An introduction of theory and research. Reading, MA: Addison-Wesley.Google Scholar
  31. Fishbein, M., Chan, D. K-S., O’Reilly, K., Schnell, D., Wood, R., Beeker, C., & Cohn, D. (1992). Attitudinal and normative factors as determinants of gay men’s intentions to perform AIDS-related sexual behaviors: A multisite analysis. Journal of Applied Social Psychology, 22, 999–1011.CrossRefGoogle Scholar
  32. Fishbein, M., & Middlestadt, S. (1989). Using the theory of reasoned action as a framework for understanding and changing AIDS-related behaviors. In V. Mays, G. Albee, & S. Schneider (Eds.), Primary prevention of AIDS: Psychological approaches (pp. 93–110). Newbury Park, CA: Sage.Google Scholar
  33. Flay, B. R. (1985). Psychosocial approaches to smoking prevention: A review of findings. Health Psychology, 4, 449–488.CrossRefPubMedGoogle Scholar
  34. Flynn, B. S., Worden, J. K., Secker-Walker, R. H., Badger, G. J., Geller, B. M., & Constanza, M. C. (1992). Prevention of cigarette smoking through mass media intervention and school programs. American Journal of Public Health, 82, 827–834.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Garcia, M. E., Schmitz, J. M., & Doerfler, L. A. (1990). A fine-grained analysis of the role of self-efficacy in self-initiated attempts to quit smoking. Journal of Consulting and Clinical Psychology, 58, 317–322.CrossRefPubMedGoogle Scholar
  36. Greene, W. C. (1993). AIDS and the immune system. Scientific American, 269(3), 99–105.CrossRefGoogle Scholar
  37. Harris, M. (1979). Cultural materialism: The struggle for a science of culture. New York: Simon & Schuster.Google Scholar
  38. Hayes, S. C. (1993). Analytic goals and the varieties of scientific contextualism. In S. C. Hayes, L. J. Hayes, H. W. Reese, & T. R. Sarbin (Eds.), Varieties of scientific contextualism. Reno, NV: Context Press.Google Scholar
  39. Hayes, S. C., Hayes, L. J., & Reese, H. W. (1988). Finding the philosophical core: A review of Stephen C. Pepper’s World hypotheses. Journal of the Experimental Analysis of Behavior, 50, 97–111.CrossRefPubMedPubMedCentralGoogle Scholar
  40. Hayes, S. C., Hayes, L. J., Reese, H. W., & Sarbin, T. R. (1993). Varieties of scientific contextualism. Reno, NV: Context Press.Google Scholar
  41. Hays, R. D. (1989). Robustness of a model of exercise. Journal of Behavioral Medicine, 12, 599–603.CrossRefPubMedGoogle Scholar
  42. Hingson, R. W., Strunin, L., Berlin, B. M., & Heeren, T. (1990). Beliefs about AIDS, use of alcohol and drugs, and unprotected sex among Massachusetts adolescents. American Journal of Public Health, 80, 295–299.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Jaccard, J. J., & Davidson, A. R. (1972). Toward an understanding of family planning behavior: An initial investigation. Journal of Applied Social Psychology, 2, 228–235.CrossRefGoogle Scholar
  44. Janz, N. K., & Becker, M. H. (1984). The health belief model: A decade later. Health Education Quarterly, 11, 1–47.CrossRefPubMedGoogle Scholar
  45. Jemmott, J. B., Jemmott, L. S., & Fong, G. T. (1992). Reductions in HIV risk-associated sexual behaviors among Black male adolescents: Effects of an AIDS prevention intervention. American Journal of Public Health, 82, 372–377.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Jemmott, L. S., & Jemmott, J. B. (1991). Applying the theory of reasoned action to AIDS risk behavior: Condom use among black women. Nursing Research, 40, 228–234.CrossRefPubMedGoogle Scholar
  47. Joseph, J. G., Montgomery, S. B., Emmons, C. A., Kessler, R. C., Ostrow, D. G., Wortman, C. B., O’Brien, K., Eller, M., & Eshlemann, S. (1987). Magnitude and determinants of behavioral risk reduction: Longitudinal analysis of a cohort at risk for AIDS. Psychology and Health, 1, 73–96.CrossRefGoogle Scholar
  48. Keeter, S., & Bradford, J. B. (1988). Knowledge of AIDS and related behavior change among unmarried adults in a low-prevalence city. American Journal of Preventive Medicine, 4, 146–152.PubMedGoogle Scholar
  49. Kelly, J. A., St. Lawrence, J. S., Betts, R., Brasfield, T. L., & Hood, H. V. (1990). AIDS Education and Prevention, 2, 24–35.PubMedGoogle Scholar
  50. Kelly, J. A., St. Lawrence, J. S., & Brasfield, T. L. (1991). Predictors of vulnerability to AIDS risk behavior relapse. Journal of Consulting and Clinical Psychology, 59, 163–166.CrossRefPubMedGoogle Scholar
  51. Kelly, J. A., St. Lawrence, J. S., Diaz, Y. E., Stevenson, L. Y., Hauth, A. C., Brasfield, T. L., Kalichman, S. C., Smith, J. E., & Andrew, M. E. (1991). HIV risk behavior reduction following intervention with key opinion leaders of a population: An experimental community-level analysis. American Journal of Public Health, 81, 168–171.CrossRefPubMedPubMedCentralGoogle Scholar
  52. Kelly, J. A., St. Lawrence, J. S., Hood, H. V., & Brasfield, T. L. (1989). Behavioral intervention to reduce AIDS risk activities. Journal of Consulting and Clinical Psychology, 57, 60–67.CrossRefPubMedGoogle Scholar
  53. Kelly, J. A., St. Lawrence, J. S., Stevenson, L. Y., Hauth, A. C., Kalichman, S. C., Diaz, Y. E., Brasfield, T. L., Koob, J. J., & Morgan, M. G. (1992). Community AIDS/HIV risk reduction: The effects of endorsements by popular people in three cities. American Journal of Public Health, 82, 1483–1489.CrossRefPubMedPubMedCentralGoogle Scholar
  54. Koss, M. P. (1990). Violence against women. American Psychologist, 45, 374–380.CrossRefPubMedGoogle Scholar
  55. Koss, M. P., Gidycz, C. A., & Wisniewski, N. (1987). The scope of rape: Incidence and prevalence of sexual aggression and victimization in a national sample of higher education students. Journal of Consulting and Clinical Psychology, 55, 162–170.CrossRefPubMedGoogle Scholar
  56. Marlatt, G. A., & Gordon, J. R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford.Google Scholar
  57. McCray, E., & Onorato, I. M. (1992). Sentinel surveillance of human immunodeficiency virus infection in sexuality-transmitted disease clinics in the United States. Sexually Transmitted Diseases, 19, 235–241.CrossRefPubMedGoogle Scholar
  58. Metzler, C. W., Noell, J., & Biglan, A. (1992). The validation of a construct of high risk sexual behavior in heterosexual adolescents. Journal of Adolescent Research, 7, 233–249.CrossRefGoogle Scholar
  59. Metzler, C. W., Noell, J., Biglan, A., Ary, D., & Smolkowski, K. (in press). The social context for high-risk sexual behavior among adolescents. Journal of Behavioral Medicine.Google Scholar
  60. Montgomery, S. B., Joseph, J. G., Becker, M. H., Ostrow, D. G., Kessler, R. C., & Kirscht, J. P. (1989). The health belief model in understanding compliance with preventive recommendations for AIDS: How useful? AIDS Education and Prevention, 1, 303–323.PubMedGoogle Scholar
  61. Monti, P. A., Abrams, D. B., Kadden, R. M., & Cooney, N. L. (1989). Treating alcohol dependence. New York: Guilford.Google Scholar
  62. Morris, E. K. (1988). Contextualism: The world view of behavior analysis. Journal of Experimental Child Psychology, 46, 289–323.CrossRefGoogle Scholar
  63. Norman, N. M., & Tedeschi, J. T. (1989). Self-presentation, reasoned action, and adolescents’ decisions to smoke cigarettes. Journal of Applied Social Psychology, 19, 543–558.CrossRefGoogle Scholar
  64. O’Leary, A., Goodhart, F., Jemmott, L. S., & Boccher-Lattimore, D. (1992). Predictors of safer sex on the college campus: A social cognitive theory analysis. Journal of American College Health, 40, 254–263.CrossRefPubMedGoogle Scholar
  65. Patterson, G. R., Reid, J. B., & Dishion, T. J. (1992). Antisocial boys: A social interactional approach (Vol. 4). Eugene, OR: Castalia.Google Scholar
  66. Pepper, S. C. (1942). World hypotheses: A study in evidence. Berkeley: University of California Press.Google Scholar
  67. Perry, C. L., Klepp, K. I., & Shultz, J. M. (1988). Primary prevention of cardiovascular disease: Community-wide strategies for use. Journal of Consulting and Clinical Psychology, 56, 358–364.CrossRefPubMedGoogle Scholar
  68. Rosenstock, I. M. (1974). The health belief model and preventive health behavior. Health Education Monographs, 2, 354–386.CrossRefGoogle Scholar
  69. Rotheram-Borus, M. J., Koopman, C., & Haignere, C. (1991). Reducing HIV sexual risk behaviors among runaway adolescents. Journal of the American Medical Association, 255, 1237–1241.CrossRefGoogle Scholar
  70. Schlegel, R. P., D’Avernas, J. R., Zanna, M. P., DeCourville, N. H., & Manske, S. R. (1992). Problem drinking: A problem for the theory of reasoned action? Journal of Applied Social Psychology, 22, 358–385.CrossRefGoogle Scholar
  71. Siegel, K., & Gibson, W. C. (1988). Barriers to the modification of sexual behavior among heterosexuals at risk for acquired immunodeficiency syndrome. New York State Journal of Medicine, 88, 66–70.PubMedGoogle Scholar
  72. Skinner, B. F. (1970). What is the experimental analysis of behavior? In R. Ulrich, T. Stachnik, & J. Mabry (Eds.), Control of human behavior. Glenview, IL: Scott, Foresman.Google Scholar
  73. Sonnabend, J., Witkin, S.S., & Purtilo, D. T. (1983). Acquired immunodeficiency syndrome, opportunistic infections, and malignancies in male homosexuals. Journal of the American Medical Association, 249, 2370–2374.CrossRefPubMedGoogle Scholar
  74. Stall, R., Ekstrand, M., Pollack, L., & Coates, T. J. (1990). Relapse from safer sex: The AIDS behavioral research project. Sixth International Conference on AIDS Abstracts, 1, 160.Google Scholar
  75. Strecher, V. J., DeVellis, B. M., Becker, M. H., & Rosenstock, I. M. (1986). The role of self-efficacy in achieving health behavior change. Health Education Quarterly, 13, 73–92.CrossRefPubMedGoogle Scholar
  76. Tobler, N. S. (1986). Meta-analysis of 143 adolescent drug prevention programs: Quantitative outcome results of program participants compared to a control or comparison group. Journal of Drug Issues, 16, 537–567.CrossRefGoogle Scholar
  77. Valdiserri, R. O., Lyter, D., Leviton, L. C., Callahan, C. M., Kingsley, L. A., & Rinaldo, C. R. (1988). Variables influencing condom use in a cohort of gay and bisexual men. American Journal of Public Health, 78, 801–805.CrossRefPubMedPubMedCentralGoogle Scholar
  78. World Health Organization. (1993). The HIV/AIDS pandemic: 1993 overview. Document WHO/GPA/EVA/93.1, Global Program on AIDS. Geneva: Author.Google Scholar
  79. Wulfert, E. (1993, May). Sexual risk behavior: An analysis and integration of the health belief, reasoned action, and self-efficacy model. Paper presented at the Conference on Behavioral Research on the Role of Condoms in Reproductive Health, Bethesda, MD.Google Scholar
  80. Wulfert, E., & Wan, C. K. (1993). Condom use: A self-efficacy model. Health Psychology, 12, 346–353.CrossRefPubMedGoogle Scholar

Copyright information

© Association for Behavior Analysis International 1994

Authors and Affiliations

  • Edelgard Wulfert
    • 1
  • Anthony Biglan
    • 2
  1. 1.Department of PsychologyState University of New York at AlbanyAlbanyUSA
  2. 2.Oregon Research InstituteEugeneUSA

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