The need to incorporate structural change - Eric Roberts and Derrick Matthews

Landmark studies find evidence for the efficacy of a microbicide gel and antiretroviral medication as pre-exposure prophylaxis. But can individualized biomedical efforts really influence the HIV epidemic at the population level? And does a successful efficacy trial justify implementation and scale up?

This Learning Lab, presented by Eric Roberts and Derrick Matthews, offers an alternative theory of health behaviour to advocate for structural interventions that target fundamental causes of disease and health. It is these underlying causes, they argue, that influence the very context in which chemoprophylactic interventions operate. The presentation focuses on the example of a recent large-scale microbicide trial in order to explore:

  • the landscape of chemoprophylaxis
  • the meaning of efficacy vs effectiveness
  • the need to assess adherence as part of the effectiveness of microbicides
  • the biomedicalisation of public health

STRIVE's Chief Executive Lori Heise highlighted the importance of Roberts and Matthews' critique:

It is  important to look at the paradigm that gives rise to the trials and the expectations attached to the technologies once they are proven. 

The webinar and discussion gained positive feedback in an online survey:

This talk was absolutely amazing! I did not even know that STRIVE existed. Now I'm completely plugged in. The talk was extremely helpful at articulating and providing the language that so adequately reflects my passion concerning the underemphasis on structural drivers of HIV and overemphasis of biomedicalization of HIV. 

For background reading browse STRIVE resources.

Eric Roberts is a doctoral candidate in the Department of Epidemiology at Columbia University and an epidemiologist in the Division of Social Epidemiology in the Department of Health Evidence and Policy at the Icahn School of Medicine at Mount Sinai. His dissertation focuses on functional drug use.

Derrick Matthews is a postdoctoral associate in the Department of Behavioral and Community Health Sciences at the University of Pittsburgh. His research is on HIV prevention among sexual minority men of colour within the United States, with a specific focus on those social determinants that pattern sexual health behaviours.

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