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I. Public health Importance of HIV/AIDS

AIDS is the acquired immune deficiency syndrome and is the finale stage of the infection caused by the human immunodeficiency virus (HIV). HIV/AIDS has a tremendous public health importance in the United States and around the globe. HIV/AIDS has negative socio-economic and demographic impacts on infected people, their relatives, their communities and their countries. Research shows that over one million individuals are living with the HIV virus in the United States, and 21 percent of the infected do not know that have the virus (Center for Disease Control and Prevention (CDC), 2008).

While the number of people living with the HIV virus has increased in recent years, the number of new cases continues to grow annually. It is estimated that there are 56,300 individuals who are newly infected with the HIV virus every year (CDC, 2008 ). The CDC estimates that over 18,000 people with AIDS die every year in the United States and that through 2007, over 576,000 individuals with AIDS have died in the United States. There is disparity of the HIV/AIDS prevalence among ethnic groups. All communities are not equally affected by the infections and the disease. More people are infected among African American than any ethnic group. African Amercians compriseabout 12 percent of population in the United States, but 46 percent living with HIV in the country are African American, and represent 45 percent of the newly infected people in this ethnic group. While the infection rate has stabilized in recent years, one in 16 African American male, and one in 30 African American women will be infected with HIV in the course of their lives.

It is estimated that “the HIV incidence rate for black women is nearly 15 times as high as that of white women, and nearly four times that of Hispanic and Latino women. The Hispanics and Latinos ethnic group make up 15 percent of the population United States, but they represent 17 percent of those who are living with HIV and 17 percent of the newly infected” (CDC 2008).

According to the World Health Organization (WHO), over 25 million persons have died from HIV infections worldwide since the beginning of HIV/AIDS epidemic. The WHO estimates that in 2008, there were about 33.4 million individuals around the globe living with HIV/AIDS, and 2.1 million of this population were children under age 15.

II. Description of the Theory

The Diffusion of Innovations Theory is being applied to the prevention of HIV/AIDS. The review of the literature shows that the diffusion of innovations theory examines how “new ideas, products, and social practices spread within an organization, community, or society, or from one society to another” (National Institute of Health, 2005). It is insufficient to design innovative prevention programs; health professionals have to spread the information in the community on a broad scale. As in the application of the Diffusion of Innovations Theory to the cancer prevention, HIV/AIDS prevention programs will not be successful if the target audience is not widely informed. The lack of large dissemination of information regarding preventive programs will lead to numerous deaths every year. Through the this theory, public health professionals can increase the number of people who are exposed to and reached by successful intervention programs, and reinforce the public health.

According to the late E.M. Rogers, diffusion of innovations is “the process by which an innovation is communicated through certain channels over time among the members of a social system.” (Rogers 1995). The Diffusion Theory has been applied to different types of health behaviors and programs, including condom use, smoking cessation, and use of new tests and technologies by health professionals. The application of Diffusion of Innovations to prevent HIV/AIDS, and promote health requires actions at some of the socio-ecological levels using different approaches. The health behavior innovation will require a lifestyle change at the individual level. At the organizational level, it may include starting programs, amending regulations, or altering personnel roles. At the community level, diffusion of innovations can take into account using the media, designing new policies, or using new approaches to preventions. According to Rogers, “a number of factors determine how quickly, and to what extent, an innovation will be adopted and diffused.”

III. Discussion of Theoretical Applications to HIV/AIDS

According to Sackett et al. (2000 ), evidence-based practice has been defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” As a way to improving evidence-based, “clinical practice guidelines have become a familiar part of physical therapist practice” (Van der Wees, et al. 2007). Research scientists are becoming more and more critical of these guidelines, because they are not broadly used after diffusion. According to (Roses 1999), “many interventions aimed at changing behavior have been pursued in the absence of clear information about the reasons why practitioners did not exhibit the preferred behavior.” As a result, “such interventions may have lacked a rationale for the choice of their content” (Grimshaw et al. 2004). The lack of proper theory eventually yields small to moderate effects. According to Grimshaw et al. (2004), additional research “into the details of actual implementation is” necessary in order to fully know the critical agents of change in reality, and such additional research should :preferably be systematic and theory based.”

Research shows that theory gives planners instruments to move beyond guessing games so that they can design and evaluate health behavior and health promotion interventions on the basis of clear understanding of the way target audience reacts. Theory helps health professionals and research scientists to take a step back and take into account all the elements of the intervention and/or health promotion programs. Research shows that intervention and prevention programs based on theory are more likely to succeed that those that are not based on theory.

As an example, due to the lack of theory in prevention and intervention programs in Papua New Guinea, “the risk factors associated with HIV outbreaks include a combination of ignorance and denial: low condom use, increasing migration and widespread incidents of domestic violence.” (Bowtell, 2007). There has been a complete failure of properly applied diffusions innovations in many ways to HIV/AIDS prevention programs. One crucial element of the diffusions innovation theory was completely missing is that disseminating the innovated information. Communication to the target audience cannot be successful if both mass media and interpersonal interactions are not taken into account. Research shows that communication usually flows through what experts describe as the two-step flow of communication. First, community leaders, who usually pay close attention to the information from the media, receive it. Second, they transmit the information received to the community members in a cultural context. Therefore in the application of the diffusions innovations theory , socio-cultural networks are important to an effective dissemination of information which is very critical to the health promotion and prevention of HIV/AIDS, especially in developing countries where media infrastructure is still primitive in certain regions. In the context of properly disseminating the information, Ratzsan (1993) argued in his book on effective health communications that despite different views on the exact role of the media in reporting HIV/AIDS, there is general agreement “that the media are an important and influential source of health and medical information, and that they shape public understandings of and responses to current epidemics.” “The media has enormous potential to help stop the spread of AIDS if they could inform the public continuously and accurately about the true nature and scope of HIV risks around the world” (Ratzan, 1993, p. 256). He stressed in the early 1990s that those in the news media “should rise above the epidemic of complacency, stigma, and denial to uncover solutions for slowing HIV infection in the most devastated areas of the world. Ratzan (1993) argues that “communication is our primary and most potent weapon in preventing the spread of HIV/AIDS. He argues that “communication is all we have; especially scientists are nowhere near finding a cure or a vaccine for HIV/AIDS.”

IV. Discussion of Future Efforts

There are conflicting reports regarding how to use some of the components of the diffusion of innovations theory applied to sex, sex self-protection and the prevention of HIV/AIDS. While some parents argue that their children need basic information about sex and sexual self-protection, another group of parents believe that their children should be well informed about all the prevention methods. A recent Dutch survey of students, parents, teachers and principals commissioned by the Kaiser Family Foundation, “parents want a wider range of topics taught than is often included in sex education today.” (Swinkels, I., et al. 2005). The survey showed that “Ninety-eight percent of parents say they want HIV/AIDS discussed in sex education classes and 85 percent want their children told how to use condoms.” The results of the same survey show that 84 percent think sex education should cover “how to use and where to get other birth control, and 76 percent want homosexuality addressed in classroom sexuality education.” (Swinkels, I., et al. 2005 ).

There should be an effort to properly combine communication theory when applying diffusions innovations theory to a health promotion and disease prevention in general, and to HIV/AIDS in particular. According to Harting J et al. (2009), communication theory examines “who says what, in which channels, to whom, and with what effects.” It assesses how messages are put together, disseminated, received, and digested. In the context of public health in general, and HIV/AIDS prevention in particular, the objective of communication is to detect, “How do communication processes contribute to, or discourage, behavior change?”(Harting et al. 2009 ). A good combination of diffusions of innovations theory with communication theory will be a powerful theory for the reduction of the prevalence of HIV/AIDS.

References

CDC. (2008). HIV prevalence estimates-US 2006. Mortality and Morbidity Weekly Report; 57(39),1073-1076. Retrieved from:

David C. Dugdale, D.C. III., and Vyas., J. M. (2011) U.S. National library of medicine. U.S department of health and human services. National institute of health.

Rogers EM. (1995) Diffusion of Innovations (4th Edition). New York, N.Y.: Free Press.

Henry J. Kaiser Family Foundation. Sex Education in America: A Series of National Surveys of Students, Parents, Teachers and Principals (Summary of Findings) (2000 September).

Bowtell, B. (2007). HIV/AIDS: The looming Asia Pacific pandemic. Sydney: The Lowy Institute for International Policy.

Kippax, S. (2007). Reflections of a social scientist on doing HIV social research. The National Centre in HIV Social Research: Sydney

Iles, R., & Davidson M. (2006). Evidence based practice: a survey of physiotherapists’ current practice. Physiother Research International. 11:93–103.

Bero LA, Grilli R, Grimshaw JM, et al. (1998). Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. British Medical Journal. 317:465–468.

Sackett DL, Strauss SE, Richardson WS, et al. (2000). Evidence-Based Medicine: How to Teach and Practice EBM. 2nd ed. Edinburgh, United Kingdom: Churchill Livingstone.

Van der Wees, P.J., Hendriks, E.J., & Custers, J.W., et al. (2007). Comparison of international guideline programs to evaluate and update the Dutch program for clinical guideline development in physical therapy. BioMed Central Health Services Research;7:191.

Poses, R. M. (1999). One size does not fit all: questions to answer before intervening to change physician behavior. Joint Commission Journal on Quality Improvement;25:486–495. Medline

Grimshaw, J.M., Thomas, R. E., MacLennan G., et al. (2004). Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment;8:1–72.

Van den Ende, C. S. I., Van den Bosch, W., et al. (2005). Physiotherapy management of low back pain: does practice match the Dutch guidelines? Australia Journal Physiotherapy; 51:35–41.

Harting, J., Rutten, G. M.J.,Rutten, S.T.J., & Kremers, S. P. (2009). Physical Therapy, 89(3): 221-232.