AIDS and Behavior

, Volume 17, Issue 6, pp 1915–1925 | Cite as

Theory, Measurement and Hard Times: Some Issues for HIV/AIDS Research

  • Samuel R. Friedman
  • Milagros Sandoval
  • Pedro Mateu-Gelabert
  • Diana Rossi
  • Marya Gwadz
  • Kirk Dombrowski
  • Pavlo Smyrnov
  • Tetyana Vasylyeva
  • Enrique R. Pouget
  • David Perlman
Original Paper


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.


Big events Hard times Cultural–historical activity theory Theory HIV Measurement 


La inestabilidad económica y política y los “grandes eventos” asociados con ella están muy extendidas en todo el mundo. Los “grandes eventos” a veces conducen a brotes epidémicos de VIH, y a veces no, y no entendemos por qué. Las actuales teorías del comportamiento no abordan adecuadamente estos procesos, y por lo tanto no pueden proveer una óptima orientación para una efectiva intervención. Basándonos en parte en una crítica a nuestro modelo de las “vías” que se interconectan durante los grandes eventos, sugerimos que la Teoría de la Actividad Histórico-Cultural (CHAT en ingles) puede proporcionar un marco útil para la investigación del VIH en esta área. Utilizamos conceptos de CHAT y también sugerimos una serie de áreas en las que las nuevas medidas se deben desarrollar para hacer posible este tipo de investigación.



The authors would like to acknowledge support from US National Institute on Drug Abuse projects R01 DA031597 (Developing measures to study how structural interventions may affect HIV) and P30 DA11041 (Center for Drug Use and HIV Research), as well as support from Fogarty International Center/NIH Grants through the AIDS International Training and Research Program at Mount Sinai School of Medicine-Argentina Program (Grant # D43 TW001037) and through SUNY-Downstate Medical Center (Grant # D43 TW000233) and by the Buenos Aires University (UBACyT 20020100101021).


  1. 1.
    Kentikelenis A, Karanikolos M, Papanicolas I, Basu S, McKee M, Stuckler D. Health effects of financial crisis: Omens of a Greek tragedy. Lancet. 2011;378(9801):1457–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Pharris A, Wiessing L, Sfetcu O, Hedrich D, Botescu A, Fotiou A, et al. Human immunodeficiency virus in injecting drug users in Europe following a reported increase of cases in Greece and Romania, 2011. Euro Surveill. 2011;16(48).Google Scholar
  3. 3.
    Paraskevis D, Nikolopoulos G, Tsiara C, Paraskeva D, Antoniadou A, Lazanas M, et al. HIV-1 outbreak among injecting drug users in Greece, 2011: a preliminary report. Euro Surveill. 2011;16(36).Google Scholar
  4. 4.
    Brudney K, Dobkin J. Resurgent tuberculosis in New York City: human immunodeficiency virus, homelessness, and the decline of tuberculosis control programs. Am Rev Respir Dis. 1991;144:745–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Stuckler D, King LP, Basu S. International Monetary Fund programs and tuberculosis outcomes in post-communist countries. PLoS Med. 2008;5(7):e143.PubMedCrossRefGoogle Scholar
  6. 6.
    Arinaminpathy N, Dye C. Health in financial crises: economic recession and tuberculosis in Central and Eastern Europe. J R Soc Interface. 2010;7(52):1559–69.PubMedCrossRefGoogle Scholar
  7. 7.
    Bonovas S, Nikolopoulos G. High-burden epidemics in Greece in the era of economic crisis. Early signs of a public health tragedy. J Prev Med Hyg. 2012;53:169–71.PubMedGoogle Scholar
  8. 8.
    Friedman SR, Rossi D, Braine N. Theorizing “Big Events” as a potential risk environment for drug use, drug-related harm and HIV epidemic outbreaks. Int J Drug Policy. 2009;20:283–91.PubMedCrossRefGoogle Scholar
  9. 9.
    Friedman SR, Rossi D. Dialectical theory and the study of HIV/AIDS and other epidemics. Dialect Anthropol. 2011;35:403–27. doi: 10.1007/s10624-011-9222-1.CrossRefGoogle Scholar
  10. 10.
    Stetsenko A, Arievitch I. The self in cultural–historical activity theory: reclaiming the unity of social and individual dimensions of human development. Theory Psychol. 2004;14:475–503.CrossRefGoogle Scholar
  11. 11.
    Nleya PTT. Facilitating expansive school transformation using ICT: a Botswana pilot project. In: GeSCI-PanAf Workshop on Research in ICT Education & Development, Lusaka, 2010.Google Scholar
  12. 12.
    Wolff-Michael R, Yew-Jin L. “Vygotsky’s Neglected Legacy”: cultural–historical activity theory. Rev Educ Res. 2007;77:186–232. doi: 10.3102/0034654306298273.CrossRefGoogle Scholar
  13. 13.
    Sellman EM. The process and outcomes of implementing peer mediation services in schools: a cultural–historical activity theory approach. Doctoral dissertation, University of Birmingham; 2003.Google Scholar
  14. 14.
    Edwards A. Working collaboratively to build resilience: a CHAT approach. Soc Policy Soc. 2007;6:255–65.CrossRefGoogle Scholar
  15. 15.
    Krinsky J, Barker C. Movement strategizing as developmental learning: perspectives from cultural–historical activity theory. In: Johnson H, editor. Culture, social movements, and protests. Surrey: Ashgate; 2009. p. 209–25.Google Scholar
  16. 16.
    Vygotsky LS. In: Cole M, John-Steiner V, Scribner S, Souberman E, editors. Mind in society: the development of higher psychological processes. Cambridge, MA: Harvard University Press; 1978.Google Scholar
  17. 17.
    Leontiev AN. Activity, consciousness and personality. Englewood Cliffs: Prentice Hall; 1978.Google Scholar
  18. 18.
    Leontiev AN. The problem of activity in psychology. In: Wertsch JV, editor. The concept of activity in soviet psychology. Armonk: Sharpe; 1981.Google Scholar
  19. 19.
    Engestrom Y. Learning, working and imagining: twelve studies in activity theory. Helsinki: Orienta-Konsultit; 1990.Google Scholar
  20. 20.
    Engeström Y. Learning by expanding: an activity/theoretical approach to developmental research. Helsinki: Orienta-Konsulit; 1987. Available on the web at
  21. 21.
    Stetsenko A. Activity as object-related: resolving the dichotomy of individual and collective types of activity. Mind Cult Act (Special Issue on the principle of object-relatedness, guest editors V. Kaptelinin and R. Miettinen). 2005;12(1)70–88.Google Scholar
  22. 22.
    Stetsenko A. From relational ontology to transformative activist stance: expanding Vygotsky’s (CHAT) project. Cult Stud Sci Educ. 2008;3:465–85.Google Scholar
  23. 23.
    Stetsenko A, Arievitch I. Cultural–historical activity theory: foundational worldview and major principles. In: Martin J, Kirschner S, editors. The sociocultural turn in psychology: the contextual emergence of mind and self. New York: Columbia University Press; 2010. p. 231–53.Google Scholar
  24. 24.
    Friedman SR, Kippax SC, Phaswana-Mafuya N, Rossi D, Newman CE. Emerging future issues in HIV/AIDS social research. AIDS. 2006;20:959–60.PubMedCrossRefGoogle Scholar
  25. 25.
    Friedman SR, Cooper HLF, Osborne A. Structural and social contexts of HIV risk among African-Americans. Am J Public Health. 2009;99:1002–8. doi: 10.2105/AJPH.2008.140327.PubMedCrossRefGoogle Scholar
  26. 26.
    Friedman SR, Rossi D, Phaswana-Mafuya N. Globalization and interacting large-scale processes and how they may affect the HIV/AIDS epidemic. In: Pope C, White R, Malow R, editors. HIV/AIDS: global frontiers in prevention/intervention. New York: Routledge, Inc.; 2009. p. 491–500.Google Scholar
  27. 27.
    Hacker MA, Leite I, Friedman SR, Carrijo RG, Bastos FI. Poverty, bridging between injecting drug users and the general population, and “interiorization” may explain the spread of HIV in southern Brazil. Health Place. 2009;15(2):514–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Roberts ET, Friedman SR, Brady JE, Pouget ER, Tempalski B, Galea S. Environmental conditions, political economy, and rates of injection drug use in large US metropolitan areas 1992–2002. Drug Alcohol Depend. 2010;106(2):142–53.PubMedCrossRefGoogle Scholar
  29. 29.
    Barnett T, Whiteside A. AIDS in the twenty-first century: disease and globalization. 2nd ed. New York: Palgrave; 2006.Google Scholar
  30. 30.
    Robinson R. From population to HIV: the organizational and structural determinants of HIV outcomes in sub-Saharan Africa. J Int AIDS Soc. 2011;14(Suppl 2):S6.PubMedCrossRefGoogle Scholar
  31. 31.
    Wallace D, Wallace R. A plague on your houses: how New York was burned down and national public health crumbled. New York: Verso; 1998.Google Scholar
  32. 32.
    Friedman SR, Sandoval M, Mateu-Gelabert P, Meylakhs P, Des Jarlais DC. Symbiotic goals and the prevention of blood-borne viruses among injection drug users. Subst Use Misuse. 2011;46:307–15. doi: 10.3109/10826084.2011.523316.PubMedCrossRefGoogle Scholar
  33. 33.
    Mateu-Gelabert P, Sandoval M, Meylakhs P, Wendel T, Friedman SR. Strategies to avoid opiate withdrawal: implications for HCV and HIV risks. Int J Drug Policy. 2010;21(3):179–85.PubMedCrossRefGoogle Scholar
  34. 34.
    Rossi D, Zunino Singh D, Pawlowicz MP, Touzé G, Bolyard M, Mateu-Gelabert P, Sandoval M, Friedman SR. Changes in time-use and drug use by young adults in poor neighbourhoods of Greater Buenos Aires, Argentina, after the political transitions of 2001–2002: results of a survey. Harm Reduct J. 2011;8:2.PubMedCrossRefGoogle Scholar
  35. 35.
    Blumer H. Society as symbolic interaction. In: Rose AM, editor. Human behavior and social process: an interactionist approach. New York: Houghton-Mifflin; 1962.Google Scholar
  36. 36.
    Flom PL, Friedman SR, Jose B, Curtis R. Peer norms regarding drug use and drug selling among household youth in a low income ‘drug supermarket’ urban neighborhood. Drugs Educ Prev Policy. 2001;8:219–32.CrossRefGoogle Scholar
  37. 37.
    Flom PL, Friedman SR, Kottiri BJ, Neaigus A, Curtis R. Recalled adolescent peer norms towards drug use and drug use in young adulthood in a low-income, minority urban neighborhood. J Drug Issues. 2001;31:425–43.Google Scholar
  38. 38.
    Kelly JA, St Lawrence JS, Brasfield TL, Lemke A, Amidei T, Roffman RE, Hood HV, Smith JE, Kilgore H, McNeill C Jr. Psychological factors that predict AIDS high-risk versus AIDS precautionary behavior. J Consult Clin Psychol. 1990;58(1):117–20.PubMedCrossRefGoogle Scholar
  39. 39.
    Pawlowicz MP, Zunino Singh D, Rossi D, Touzé G, Wolman G, Bolyard M, Sandoval M, Flom PL, Mateu-Gelabert P, Friedman SR. Drug use and peer norms among youth in a high-risk drug use neighbourhood in Buenos Aires. Drugs Educ Prev Policy. 2010;17(5):544–59.CrossRefGoogle Scholar
  40. 40.
    Friedman SR, Jose B, Neaigus A, Goldstein M, Curtis R, Ildefonso G, Mota P, Des Jarlais DC. Consistent condom use in relationships between seropositive injecting drug users and sex partners who do not inject drugs. AIDS. 1994;8(3):357–61.PubMedCrossRefGoogle Scholar
  41. 41.
    Friedman SR, Neaigus A, Jose B, et al. Networks, norms, and solidaristic/altruistic action against AIDS among the demonized. Sociol Focus. 1999;32:127–42.CrossRefGoogle Scholar
  42. 42.
    Des Jarlais DC, Perlis T, Arasteh K, Hagan H, Milliken J, Braine N, Yancovitz S, Mildvan D, Perlman DC, Maslow C, Friedman SR. “Informed altruism” and “partner restriction” in the reduction of HIV infection in injecting drug users entering detoxification treatment in New York City, 1990–2001. J Acquir Immune Defic Syndr. 2004;35(2):158–66.PubMedCrossRefGoogle Scholar
  43. 43.
    O’Dell BL, Rosser BR, Miner MH, Jacoby SM. HIV prevention altruism and sexual risk behavior in HIV-positive men who have sex with men. AIDS Behav. 2008;12(5):713–20.PubMedCrossRefGoogle Scholar
  44. 44.
    Convey MR, Dickson-Gomez J, Weeks MR, Li J. Altruism and peer-led HIV prevention targeting heroin and cocaine users. Qual Health Res. 2010;. doi: 10.1177/1049732310375818.PubMedGoogle Scholar
  45. 45.
    Booth RE, Des Jarlais DC, Friedman SR. Reflections on 25 years of HIV and AIDS research among drug abusers. J Drug Issues. 2009;39:209–22.CrossRefGoogle Scholar
  46. 46.
    Friedman SR, de Jong W, Rossi D, Touzé G, Rockwell R, Des Jarlais DC, Elovich R. Harm reduction theory: users culture, micro-social indigenous harm reduction, and the self-organization and outside-organizing of users’ groups. Int J Drug Policy. 2007;18:107–17.PubMedCrossRefGoogle Scholar
  47. 47.
    Friedman SR, Maslow C, Bolyard M, Sandoval M, Mateu-Gelabert P, Neaigus A. Urging others to be healthy: “intravention” by injection drug users as a community prevention goal. AIDS Educ Prev. 2004;16:250–63.PubMedCrossRefGoogle Scholar
  48. 48.
    Friedman SR, Bolyard M, Maslow C, Mateu-Gelabert P, Sandoval M. Harnessing the power of social networks to reduce HIV risk. Focus. 2005;20(1):5–6.PubMedGoogle Scholar
  49. 49.
    Mateu-Gelabert P, Bolyard M, Maslow C, Sandoval M, Flom PL, Friedman SR. For the common good: a method to measure residents’ efforts to protect their community from drug and sex related harm. SAHARA J. 2008;5:144–57.PubMedCrossRefGoogle Scholar
  50. 50.
    Friedman SR, Mateu-Gelabert P, Curtis R, Maslow C, Bolyard M, Sandoval M, Flom PL. Social capital or networks, negotiations and norms? A neighborhood case study. Am J Prev Med. 2007;32(6S):S160–70.PubMedCrossRefGoogle Scholar
  51. 51.
    Wohlfeiler D. Structural and environmental HIV prevention for gay and bisexual men. AIDS. 2000;14(Supplement 1):S52–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Wohlfeiler D. From community to clients: the professionalisation of HIV prevention among gay men and its implications for intervention selection. Sex Transm Infect. 2002;78(Supplement 1):i176–82.PubMedCrossRefGoogle Scholar
  53. 53.
    Levins R, Lewontin R. The dialectical biologist. Cambridge: Harvard University Press; 1985.Google Scholar
  54. 54.
    Lewontin R, Levins R. Biology under the influence: dialectical essays on ecology, agriculture, and health. New York: Monthly Review Press; 2007.Google Scholar
  55. 55.
    Taylor P. Unruly complexity: ecology, interpretation, and engagement. Chicago: University of Chicago Press; 2005.CrossRefGoogle Scholar
  56. 56.
    El-Sadr WM, Mayer KH, Hodder SL. AIDS in America—forgotten but not gone. N Engl J Med. 2010;362(11):967–70. doi: 10.1056/NEJMp1000069.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Samuel R. Friedman
    • 1
  • Milagros Sandoval
    • 1
  • Pedro Mateu-Gelabert
    • 1
  • Diana Rossi
    • 2
    • 3
  • Marya Gwadz
    • 4
  • Kirk Dombrowski
    • 5
  • Pavlo Smyrnov
    • 6
  • Tetyana Vasylyeva
    • 7
  • Enrique R. Pouget
    • 1
  • David Perlman
    • 8
  1. 1.Institute of Infectious Diseases ResearchNational Development and Research Institutes, Inc.New YorkUSA
  2. 2.Intercambios Civil AssociationBuenos AiresArgentina
  3. 3.Social WorkUniversity of Buenos AiresBuenos AiresArgentina
  4. 4.New York University School of NursingNew YorkUSA
  5. 5.Department of AnthropologyJohn Jay College of Criminal JusticeNew YorkUSA
  6. 6.International HIV/AIDS Alliance in UkraineKyivUkraine
  7. 7.Department of Epidemiology at the School of Public HealthSUNY-AlbanyAlbanyUSA
  8. 8.Division of Infectious DiseasesBeth Israel Medical CenterNew YorkUSA

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