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...of social change agents, advocates community participation in the research process, and encourages the dissemination of successfully tested models. In so doing, ESID provides a rational, humanitarian, and experimental framework for integrating science into social policy decisions. Within the ESID perspective, the scientist is an active participant in the change process; more often than not he/she serves as its leader. The ESID scientist/change agent differs from others in that he/she is: 1) committed to solving a human problem; 2) approaches change with a social action orientation and humanitarian values; 3) advocates a model that has been experimentally tested; and 4) utilizes experiments as ways to promote change until the model is widely adopted (Fairweather, 1967).
ESID proceeds through four distinct phases--planning, action, evaluation, and dissemination (Fairweather, 1967). It traces the innovation process from initial model-building efforts, to continuous evaluation of the newly developed solutions and ultimately to their widespread adoption. In the first two phases, a multidisciplinary team which includes representatives from the community: 1) defines a social problem; 2) designs a model to address the problem; 3) develops a plan for its evaluation; and 4) garners the human and fiscal resources to evaluate the model. The first experimental test of the model is conducted in Phase 3, whereas in Phase 4, the model is revised, replicated, and expanded.
One of the most pressing problems of the past two decades has been the global spread of the human immunodeficiency virus (HIV) and acquired immuno deficiency syndrome (AIDS). Since the early years, the HIV epidemic has been a public health emergency as well as a social challenge. AIDS remains a fatal disease; an effective vaccine has not yet been developed. Except for perinatal transmission that can be reduced by prophylatic treatment, behavior change continues to be the best primary prevention strategy currently available (Stoto, Almario, & McCormick, 1999).
Many social scientists have been instrumental in our nation's response to the HIV epidemic and have used one or more of the guiding principles of ESID. Some scientists have directed their social change efforts towards model building experiments. With the active participation of the affected communities and guided by humanitarian values, they designed new social models for HIV prevention. They then conducted longitudinal experiments in naturalistic settings to test the efficacy of these interventions (Hobfall, Jackson, Lavin, Britton, & Shepherd, 1994; Jemmott, J. B., Jemmott, Spear, Hewitt, & Cruz-Collins, 1992; Kelly et al., 1994; Kelly, St. Lawrence, Hood, & Brasfield, 1989b; Nyamathi, Flaskerud, Bennett, Leake, & Lewis, 1994; Rotheram-Borus, Koopman, & Haignere, 1992; St. Lawrence, Brasfield, Jefferson, Alleyne, & O'Brannon, 1995). A subset of these investigators exhibited some of the characteristics of ESID change agents (e.g. Jemmott and Jemmott, Kelly) by strongly advocating for adoption of the successful models through direct community service, technical assistance, as well as conducting dissemination experiments.
A small cadre of scientists selected advocacy, policy-making, and grassroots organizing as their vehicle for creating social change. For instance, some scientists became congressional staffers or lobbyists and helped to craft legislation that impacted funding streams for research, service, and treatment of HIV (e.g. Morin). They organized congressional briefings and invited their university-based colleagues to participate by making compelling, data driven presentations. Others assumed leadership and staff positions in local, state, and federal governments (e.g. Fernandez, Feis). As government employees, these scientists were involved with funding decisions thereby shaping research, service, and treatment efforts. For instance, they developed program announcements to stimulate research in new areas and worked to ensure that innovative models were positively reviewed. Direct service through community-based activities or advocacy organizations was selected by others as their way to promote social change (e.g., Miller, Solarz). Others (e.g., Jemmott, Kelly, Rotheram-Borus, Coates) remained within university settings, but assumed much more active roles in the legislative process making regular presentations to Congressional Committees and participating as panel members in Congressionally mandated studies (e.g., Auerbach, Wypijewska, & Brodie, 1994; Coyle, Boruch, & Turner, 1991; Miller, Turner, & Moses, 1990; Stoto et al., 1999). By sharing the latest scientific data and providing accurate representation of the affected communities' perspective and issues, many social scientists were instrumental in the authorization and reauthorization of AIDS-related legislation (e.g., the Ryan White Comprehensive AIDS Resource Emergency Act of 1990 Public Law #104-146), and in increasing the amount of resources appropriated for HIV-related biomedical and prevention research, treatment, and services.
Despite the active role taken by many social scientists in addressing the social, medical, and public health challenges posed by the HIV epidemic, there are relatively few published examples that apply the four phases of ESID. Perhaps the clearest application of ESID to HIV prevention is a series of model-building and replication experiments conducted by Kelly et al. (Kelly et al., 1990a, 1991, 1992, 1995, 1997; Sikkema et al., 1996). In this model, bartenders were trained to identify opinion leaders from within a community. These opinion leaders were then recruited, trained, and engaged to serve as behavior change advocates and safe-sex endorsers to others in their natural social networks. Currently, the model is being used by community-based organizations in many cities around the country and has been adopted as part of health education and risk reduction efforts both nationally and internationally (Kelly et al., 1997; J. A. Kelly, personal communication, August 14, 1999). In this paper, we describe Kelly's innovative social model as it evolved through the four phases of ESID, thereby illustrating its application to HIV prevention. During the time when many of these experiments were being implemented, Dr Fernandez worked at the Office on AIDS at the National Institute of Mental Health, the funding organization. Dr Kelly is an author of the paper.
USING ESID PRINCIPLES TO DEVELOP, TEST, AND DISSEMINATE A NEW SOCIAL MODEL
Applying ESID first requires the creation and evaluation of a model that meets the needs of the affected community. To be faithful to ESID principles, the model creation process must address a pressing social issue, be guided by humanitarian values, and include representatives of the affected community as integral members of the research team. Once the model is created, it must be rigorously evaluated. If the initial evaluation demonstrates that the model successfully addresses the social issue, replicate experiments should be conducted. Only if the experimental findings hold across the replicates, should the model be disseminated widely. In this section we describe how Kelly applied ESID principles in the development, evaluation, and dissemination of his innovative program to reduce transmission of HIV infection among gay men.
HIV Epidemic as a Pressing Social Issue
During the past two decades, HIV has become a global, infectious disease epidemic. AIDS has been diagnosed in virtually all countries. HIV infection rates have increased alarmingly in many developing countries, particularly in subSaharan Africa and Asia where heterosexual contact is the primary mode of transmission. HIV has been a major public health problem in the United States, Europe, and Central and South America as well.
By the end of 2001, 807,075 Americans had been diagnosed with AIDS and more than 467,910 had died of the disease (Centers for Disease Control and Prevention [CDC], 2001). Between 1991 and 1995, HIV infection was the leading cause of death in the United States for men aged 25-44 (National Center for Health and Statistics, 1998). By 1999, AIDS had declined to be the fifth most common cause of death among persons in that...
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