Exporting Behavior Modification Models to a Us Colony: Public Health Workers and Hiv/aids Prevention in Puerto Rico

For the past decade, the Centers for Disease Control and Prevention have emphasized the use of HIV/AIDS prevention models that explicitly incorporate theoretically-grounded, behavior modification models to establish its funding priorities for the US and its territories. This essay argues that this emphasis on behavior modification models raises a unique set of concerns for those conducting HIV/AIDS prevention campaigns in a colonial setting, such as Puerto Rico. Specifically, this paper examines US efforts to control the spread of HIV within three marginalized populations—injection drug users, sex workers and gay men—by tightening surveillance and introducing models of social control that target private, personal behaviors. A parallel is drawn between early industrial Taylorism (as a form of social control within the factory) and public health interventions designed to foster social control within a colonial setting. Four specific interventions in Puerto Rico are presented and examples of their applications are analyzed. These include: The Health Belief Model, The Theory of Reasoned Action, Social Cognitive Theory and The Transtheoretical Model. In concert with the objective of social control, it is maintained that such interventions have had a fundamentally depoliticizing effect among marginalized populations in Puerto Rico. The common underlying principles of these models, it is argued, operate to thwart collective action and undermine broad-based community efforts. This has both strengthened US colonial rule while compromising the efficacy of HIV prevention efforts.