Frontiers in the Behavioral Epidemiology of HIV/STDs
Joseph A. Catania
M. Margaret Dolcini
Judith Tedlie Moskowitz
Ariane van der Straten
University of California, San Francisco
This chapter discusses the field of HIV/STD behavioral epidemiology with a special emphasis on heterosexual adults.1 We have limited our review of the extensive HIV-behavioral epidemiological literature to include an in-depth examination of the following topic areas considered pivotal to understanding the spread of HIV/STDs. The topic areas, including sexual mixing and networks, mapping risk behavior, and the conceptualization of the several dimensions related to sexual relationships, parallel the following general aims (listed later) of the field (Catania & Binson, 1992; Catania et al., 1993; Dolcini, Coates, Catania, Kegeles, & Hauck, 1995): (a) prevention behaviors and beliefs (mapping studies), and assessment of how these change over time; (b) identification of social vectors related to the spread and prevention of HIV/STDs (e.g., how people within a particular social stratum sexually interact with other social strata); and (c) development of explanatory models for understanding onset, maintenance, and change in the patterns of behavior related to HIV/STD transmission. In short, the primary goals of behavioral epidemiology are to predict potential routes of future disease spread, target population segments for prevention, and generate an understanding of the causes of safe and unsafe behaviors.
Prior work on the first two aims includes research on the geography of disease spread (e.g., Golub, Gor, Bi; Gould, 1993; Wallace, 1991, 1994), studies on the risk behaviors of travelers (e.g., Choi, Catania, Coates, Hyung, & Hearst, 1992), research on sexual networks (e.g., Service & Blower, 1995), and at the population level, investigations of the size and characteristics of at risk populations with respect to HIV testing, condom use, and risk practices (e.g., Catania, Binson, et al., 1995; Catania, Stone, Binson, & Dolcini, 1995).
There have been a number of national and urban surveys on aspects of the behavioral epidemiology of HIV infection for representative samples of adults (e.g., Catania, Coates, 8z Kegeles, 1994; Catania, Coates, Kegeles, Thompson-Fullilove, et al., 1992; Catania, Coates, Kegeles, Ekstrand, et al., 1989; Catania et al., 1993; Choi, Catania, & Dolcini, 1994; Dolcini et al., 1993; Grinstead, Faigeles, Binson, & Eversley, 1993; Hingson et al., 1989; Kanouse et al., 1991; Keeter & Bradford, 1988; Kost & Forrest, 1992; Laumann, Gagnon, Michael, & Michaels, 1994; Leigh, Temple, & Trocki, 1993; Marin, Gomez, &Hearst, 1993; Peterson, Catania, Dolcini, & Faigeles, 1993; Sabogal, Pierce, Pollack,____________________