Some problems for interventions encouraging community change
Tim Rhodes and Alan Quirk
Most community interventions share an understanding that individualistic models of intervention are limited in their scope for achieving or sustaining behaviour change. It is recognised that HIV prevention interventions need to target more than individuals and individual behaviour change alone. This has led to the advocacy of social models of behaviour change among populations affected by HIV infection and AIDS.
Social models caution against the restrictive vision of individualistic models which tend to view health behaviour change as simply a product of an individual’s perceptions, health beliefs and decision-making. They demand a more inclusive vision of change which encompasses both individual beliefs and behaviours and the factors which interact with these to influence the ways in which individuals think and behave. Interventions which conceive of individuals as the single or primary target and agent of change often exclude the possibility for facilitating concomitant changes in wider peer group and community norms about risk and health which help to mould, routinise and regulate individualised thinking and behaviour.
The common tendency to reduce ‘behaviour change’, and the factors which precipitate or influence such change, to the individualised unit of one is fast becoming outmoded by intervention models which target interconnected groups of individuals and social relationships as agents of change (Rhodes, 1993; Friedman et al., 1992). Most of the chapters in this book share an understanding that individuals’ attempts at behaviour change are often influenced by the ways in which other individuals think and behave. Interventions thus need to focus on changing the dynamics of how groups of individuals behave, and not simply on atomised individuals.
This chapter focuses on the problems and possibilities associated with sexual behaviour change among users of heroin. We begin by outlining the ways in which dominant research paradigms have studied ‘risk’ and ‘risk behaviour’. Research definitions of ‘risk’ are discussed in the light of their implications for understanding how everyday norms influence the ways in which people perceive risk and act in response to risk. This then allows for an examination of how ‘sexual risk’ is perceived among heroin users and of