ABSTRACT
HIV/AIDS prevention in developing countries has apparently achieved rather little despite massive expenditure on information and services. Increasingly, the effectiveness of a public health approach to the problem is doubted and fundamental changes in poverty, gender inequality, and culture are seen as necessary to stem severe generalized epidemics. We draw upon the much more extensive experience of family planning programs, which share key characteristics with HIV prevention, to argue that this perspective is profoundly mistaken. The family planning literature shows that modern contraception was initially greeted with suspicion and fear. In many countries, initial uptake of contraception was slow and this led many commentators to reiterate the view that poverty, gender inequality, and culture represented intractable barriers to reproductive change. History now shows that these barriers were illusory. We present an explanation for the lagged response to family planning
exhortations and services and the speed with which changes in reproductive behavior eventually spread across whole societies. The central reason for the frustrating slowness of response is that the problems, and especially the remedies, were socially constructed in the West and were considered alien in the other regions of the world. Thus, for behavior to change, the definition of the problem and of the solutions must first be domesticated, a process that occurs in the local social networks where international and national messages are evaluated and reinterpreted. In essence, this domestication of the agenda involves the passing of ownership from the domain of officialdom to people themselves. The explanation has direct relevance to the AIDS control movement.
