HIV/AIDS Research

San Francisco's response to the AIDS epidemic triggered a dramatically altered sense of community

San Francisco is the U.S. city most affected by the AIDS epidemic, with nearly two out of 100 San Franciscans dying of AIDS-related complications. San Francisco's response to the epidemic, which began in the early 1980s, dramatically altered that city's notions of community by 1995, according to a study supported by the Agency for Health Care Policy and Research (HS07610).

The epidemic gave previously noninteracting neighborhoods, for example, Hispanics, blacks, and gay white men, a common language of discourse, that of HIV (human immunodeficiency virus) prevention and AIDS caregiving. Representatives of these groups now perceive common goals and shared concerns, even though they may still compete with one another for HIV/AIDS funding and attention, explains James W. Dearing, Ph.D., the study's lead investigator.

He and colleagues at the University of New Mexico and the University of California, San Francisco, interviewed staff of San Francisco's 20 most highly targeted HIV prevention programs. These interviews revealed three waves of prevention efforts. The city's initial prevention effort from 1981-1987, which involved a proliferation of education and support groups, was spearheaded by gay men, many of whom were HIV-positive or had AIDS. In 1988, the AIDS epidemic began to infect minorities, who demanded city funding for prevention programs aimed at their groups. As groups began jockeying for funding, organizations fine-tuned their prevention messages to audiences defined by their age, ethnicity, sex, sexual orientation, language spoken, alcohol use, and drug use. Finally, in 1994, the city's Department of Public Health encouraged proposals for groups to form coalitions to provide prevention and support services.

HIV prevention activities in San Francisco in the 1980s achieved a high rate of awareness of HIV and a dramatic reduction in high-risk behavior among certain populations, especially gay white men. Targeting HIV/AIDS prevention efforts to unique groups, particularly by members of these groups, was responsible for much of the success of San Francisco's HIV/AIDS prevention efforts, according to a related study by Dr. Dearing and colleagues. They studied strategies based on social marketing and diffusion of innovation concepts in HIV prevention programs targeted to unique populations in San Francisco from 1993-1995. They found that barriers to reaching unique population groups, which are typically closed to outsiders, were overcome by using interpersonal communication about HIV and AIDS from members of that group. Repeated in-person interactions enabled "insider" program personnel to establish trust and credibility.

For more information, see "Communication and community in a city under siege: The AIDS epidemic in San Francisco," by Everett M. Rogers, Ph.D., Dr. Dearing, Nagesh Rao, Ph.D., and others, in the December 1995 issue of Communication Research 22(6), pp. 664-678; and "Respecifying the social marketing model for unique populations," by Gary Meyer, Ph.D., and Dr. Dearing, in the Winter 1996 issue of Social Marketing Quarterly, pp. 44-52.

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