Defining HIV Risk and Determining Responsibility in Postsocialist Poland

Abstract

Drawing on 15 months of ethnographic research on HIV prevention programs in Poland, I explore the consequences of the shift from models of HIV prevention that emphasize “risk groups” and AIDS blame, to models that focus on “risky behaviors” and universal risk. The centrality of choice making and individual risk management in these models suggests objective risk assessment free from moralizing arguments. The Polish national prevention strategy shifted to focus on choice making, address all risk groups, and include concrete prevention strategies. This shift created a backlash that resulted in the reassertion of moral arguments about risk and risk groups that positioned those most vulnerable to HIV outside the purview of prevention efforts. AIDS organizations working with marginalized, “morally problematic” populations used the label “at risk” to legitimize claims to resources. They enacted a model of risk reduction in which the relevant actor is the individual buffeted by social forces, and behavior change, and therefore HIV risk reduction, is a long process because of myriad forms of vulnerability clients face. Despite efforts to reconceptualize risk, organizations positioned the individual as the locus of HIV prevention interventions, rather than attempting to address the social context that shapes risk.

High Percentage of Recent HIV Infection Among HIV-Positive Individuals Newly Diagnosed at Voluntary Counseling and Testing Sites in Poland

“…The annual number of clients increased sixfold from 2001 to 2007, and in 2006-2007 over 20% of all newly diagnosed HIV infections in Poland were detected in the VCT network. 15,16 The system is complemented by general population campaigns encouraging people to test because of recent risky behavior and because of various life situations such as a new relationship or traveling abroad.…”

NGO Hybridisation as an Outcome of HIV Services Delivery in Global Fund-Supported Programmes in Ukraine

“…Doctoral research recently completed by the author aimed to close some of these gaps by providing specific, country-based evidence of how the GF programmes were implemented by PR NGOs in Ukraine, using as an example delivery of HIV prevention services in GF R1 and R6 (2003-2012). In line with a significant body of research of aid programmes in post-communist countries (represented in works by Atlani-Duault 2007;Hrycak 2007;Kichorowska-Kebalo 2011;Owczarzak 2009;Wedel 2001 and others), a critical ethnographic enquiry was chosen as the research approach. Primary data were collected through the 50 in-depth, open-ended interviews with key stakeholders with experience in GF programmes, based in Kyiv, and in three oblasts 8 of Ukraine.…”

Evidence-based HIV prevention in community settings: provider perspectives on evidence and effectiveness

“…They learn. [Female, 50s, direct service staff, 8 years with agency] This broader interpretation of what constitutes effectiveness makes sense in the context of the ways in which service providers understand what they can offer their clients (Owczarzak 2009). …”