The State of Social and Political Science Research Related to HIV: a Report for the International AIDS Society
Marlise Richter
Examining the State of HIV-related Social and Political Science Research
http://www.iasociety.org/Default.aspx?pageId=5&elementId=12673
Author: Susan Kippax and Martin Holt, University of New South Wales, Sydney
25 May 2010
In response to concerns of a number of social and political scientists, the International AIDS Society (IAS) commissioned a report to review the state of the art in HIV-related social and political research in HIV prevention, treatment and care. The aim of The State of Social and Political Science Research Related to HIV: a Report for the International AIDS Society was to assess the barriers and incentives to the participation of the social and political sciences in HIV research so that the IAS can better encourage and support social and political science research through its activities, particularly the international conferences it convenes.
On the basis of expert opinion from 50 social and political scientists and an analysis of the HIV-related research literature (2005–2009), the report documents the increasing importance afforded the biomedical sciences and the concomitant sidelining of the social and political sciences in HIV prevention, treatment and care. Given that HIV is a profoundly social disease, and its causes and consequences are embedded deeply in social, cultural and political processes, this state of affairs is a cause for concern. As HIV transmission continues to increase in many countries and universal access to treatments continues to be an unmet aspiration, social and political sciences are essential to complementing and strengthening biomedical research and identifying ways forward in the global pandemic.
The report, which was published by the IAS in December 2009, describes the current ‘divide’ between biomedical and social and political sciences and the reasons for it, and outlines a number of recommendations for a way forward.
The ‘Divide’
While a small number of the 50 key informants were trained in epidemiology and public health, the majority were initially trained in sociology, psychology, anthropology and politics. However, many of them now conduct HIV research in interdisciplinary environments, dedicated HIV organizations and public health departments. Most of the key informants came from North America, Europe and Australasia; some were from southern Africa and South America; and one from Asia.
All key informants agreed on the importance of social science perspectives in understanding HIV epidemics and guiding responses to them: most asserted that social and political sciences were central to a successful response to HIV, especially to HIV prevention. They stressed that HIV prevention based on collective behaviour change had been demonstrated repeatedly to be effective, and that successful approaches had engaged with groups, communities, institutions and governments to normalise and reinforce protective behaviours, rather than exclusively focusing on individuals. The key informants agreed that social and political scientists are best positioned to suggest how effective (rather than efficacious) responses might be best achieved. They therefore decried the ‘divide’ between social and political sciences, on the one hand, and biomedical sciences, on the other, many stating that the marginalization of social and political sciences within the HIV field had weakened effective responses. As one researcher noted:
“... the introduction of the protease inhibitors in the late 1990s consolidated a subsequent phase of medicalisation and normalisation of HIV. The embrace of medicine brought more resources into treatment and prevention, helped de-stigmatize HIV-positive people and increasingly depoliticized HIV. But it also helped turn desires and practices into “behaviour”, repositioned community activists as “patients” or “volunteers”, and focused the search for solutions on the wait for biomedical techno-fixes (such as post/pre-exposure prophylaxis, microbicides or circumcision). This shift has been marked by a great deal of resources being placed into biomedical prevention with very few results…The outcome has been inadequate investment in social research.”
The tenuous or poorly supported position of social and political research on HIV was seen by the key informants to be driven by a constellation of factors including:
- poor recognition of the value of social science research
- failure of social scientists in making their findings accessible
- exclusion of social and political science approaches from funding frameworks and from conferences
- lack of social science representation on peak bodies, editorial boards and funding agencies.
Furthermore, while some key informants believed it was extremely important for social and political scientists to maintain a critical perspective on developments within the HIV field, it was a risky endeavour in a field dominated by biomedical research.
The analysis of HIV literature – a mapping of the most commonly published types of social and political science research on HIV – demonstrated that social and political research on HIV is best represented in non-HIV-focused social science journals such as Social Science & Medicine. Indeed there are no social science journals devoted to HIV and AIDS, although there are journals devoted to HIV-related behavioural research, such asAIDS & Behavior, AIDS Care and AIDS Education and Prevention. Research investigating the social-cultural and political drivers of HIV and the social, political or economic impact of HIV and AIDS is poorly represented in medical journals, both those devoted to HIV and AIDS as well as public health journals, and in behavioural journals. Relatively few papers published in the medical and behavioural journals investigated social drivers and social/economic impact (28.4% and 17.6% respectively); the majority of papers published in these journals focused on interventions, both biomedical and social/behavioural interventions.
As a result, biomedical researchers in HIV, who mostly read medical or specialist HIV journals, are unlikely to be well informed about current developments in social and political research, particularly research investigating the contexts and the drivers of sexual and other risk practices and related HIV transmission. This finding clearly produces – at least in part – the perception that social scientists have failed to make the findings of their research readily accessible to HIV researchers outside the field.
The lack of a social and political science track at the IAS Conference on HIV Pathogenesis, Treatment and Prevention and an exclusive focus on biomedical prevention and separate discipline tracks at the International AIDS Conference exacerbate the divide between the biomedical sciences and the social and political sciences.
Negotiating the Biomedical
Key informants believed that there were two ways in which social and political scientists could respond to this divide. They spoke of accommodation by adapting to the priorities of biomedicine and public health, and of resistance by maintaining an autonomous HIV social science agenda. Both strategies clearly have strengths and weaknesses.
While building bridges between social science, public health and biomedicine was seen as a priority, with many social and political researchers already working with biomedical researchers in joint HIV research, the agenda for such collaborative work is often dominated by public health priorities, and incorporating social science research questions was deemed by most key informants to be difficult. Truly collaborative work requires biomedical researchers and social and political scientists to understand more about each other’s ways of working.
While some key informants believed that promoting interdisciplinary training and dialogue was important in strengthening the place of social and political sciences in HIV research, others noted the value of the social and political sciences retaining their autonomy to generate ideas and perspectives, including a critique of biomedicine. As one researcher noted:
“We need the social sciences as sources of critique of the biomedicalisation of HIV prevention. The social sciences are needed because they are a source of questions about and critique of our current arrangements that are not posed by the health sciences.”
Priority Research Issues
The key informant interviews and the mapping of the literature identified a number of priority issues and gaps in research. Among these was a call for more detailed work on the role of social and political drivers in HIV transmission, especially in developing structural interventions for HIV prevention. Research investigating HIV stigma and related discrimination was also identified as key to understanding why people fail to come forward for testing and treatment. Such research involves investigating the manner in which individuals and communities understand HIV and the medical and public health responses to the epidemic.
Key informants also noted that the conceptual confusion surrounding efficacy (what works) and effectiveness (what works in practice) in HIV interventions requires further attention. For instance, there was concern among many participants that biomedical prevention technologies may prove to be efficacious, but not actually work when used by people under real-world conditions. The positioning of randomized controlled trials as the gold standard of evidence has also meant that appropriate evidence for the effectiveness of complex prevention programmes has been difficult to establish. These issues underlined a key theme of this review – the need for equitable, interdisciplinary cooperation between social and political scientists and biomedical researchers.
Recommendations to the IAS
The analysis of the literature and the key informants’ contributions suggest a number of ways in which the IAS could strengthen the contribution of social and political sciences to the HIV field. These include: The analysis of the literature and the key informants’ contributions suggest a number of ways in which the IAS could strengthen the contribution of social and political sciences to the HIV field. These include:
- promoting social and political research as an element of all major trials of HIV-prevention interventions so that social and political implications are considered
- lobbying for increased funding of social and political research on HIV from all major funding agencies
- promoting the building of social and political science research capacity, especially in low-income countries
- supporting a social science journal devoted to HIV and AIDS and promoting the institutionalization of social and political science editors for specialist HIV journals, such as AIDS, as has recently been done for the Journal of the International AIDS Society
- actively promoting social and political science experts to stand as candidates for its governing body, as well as those of other international HIV organizations and funding agencies
- taking the initiative to support an international HIV social and political science network, governed by leading social and political researchers, that could offer a social and political science conference to complement the current international AIDS conferences, including the AIDS Impact Conference
- including a social and political sciences track at the IAS Conference on HIV Pathogenesis, Treatment and Prevention
- reorganizing the tracks at the International AIDS Conference to encourage a ‘meeting of minds’ from across the disciplines and/or holding symposia and/or events focused on social and political science analysis of biomedical topics.