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"Intravention," prevention activities that are conducted by and sustained through ongoing actions of members of communities-at-risk, is an appropriate goal for HIV intervention activities. Data from 120 injection drug users in a Brooklyn, New York, neighborhood that has seen decreases in HIV prevalence among IDUs and little HIV diffusion to young adults indicate that most of them have recently (3 months) urged other people to engage in one or more self-protective actions. These data suggest that the common image of IDUs as simply being sources of social and medical problems is inaccurate. Research is needed into how to create and diffuse "communities of intravention; " and we suggest that behavioral interventions be evaluated for their success or failure at creating outward-focused health communication by participants as well as for their impact on individual risk behaviors.
Much of the literature on HIV prevention and on drug users tends to focus on the individual, whether as the target for behavioral change interventions or as persons with behavioral and/or psychological dysfunctions. This article presents evidence about processes that may be of major importance for HIV prevention that are primarily ignored by these perspectives.
Individual-behavioral models in HIV research and intervention have primarily had a cognitive-behavioral focus. They include the transtheoretical model (De Zoysa et al., 1995; Galavotti, Grimley, Riley, & Prochaska, 1993; Prochaska & DiClemente, 1986; Proschaska, DiClemente, & Norcross, 1992; Prochaska, Redding, Harlow, Ross, & Velicer, 1994; Robles et al., 1998), health belief model (Brown, DiClemente, & Reynolds, 1991; Catanaia, Kegeles, & Coates, 1990; Edem & Harvey, 1988; Rosenstock, Strecher, & Becker, 1994), social cognitive (learning) theory (Bandura, 1977, 1986, 1994; Kok, de Vries, Mudde, & Strecher, 1991; Wexler, Magura, Josepher, Bixler, & Beardsley, 1994), theory of reasoned action (Ajzen & Fishbein, 1990; Fishbein, Middlestadt, & Hitchcock, 1994; Kalichman & Hospers 1997), and AIDS risk reduction model (Catania et al., 1990; Moore, Harrison, & Doll, 1994; Prochaska etal., 1994). The goal of these models in HIV interventions is to promote individual behavior change, or perhaps to encourage movement toward "intention to change," by changing individuals' knowledge, attitudes, beliefs, and/or emotions. Evaluation of such interventions, then, consists of seeing whether individual change results as a consequence of exposure to the intervention.
Since the mid-1980s, however, our research...