Biomedical and development paradigms in AIDS prevention

In the fight against the HIV/AIDS pandemic different approaches can be dist inguished, reflecting professional backgrounds, world views and political i nterests. One important distinction is between the biomedical and the devel opment paradigms. The biomedical paradigm is characterized by individualiza tion and the concept of "risk". This again is related to the concept of the market where health is a product of services and progress a series of new discoveries that can be marketed. The development paradigm is characterized by participation of the different stakeholders and by community work. The concept "vulnerability" is important in the development paradigm and emphas is is placed on efforts to decrease this vulnerability in a variety of sust ainable ways. Biomedical technology is definitely one of the tools in these efforts. In the beginning of the pandemic the biomedical approach was impo rtant for the discovery of the virus and understanding its epidemiology. La ter, stakeholders became involved. In the light of absence of treatment or vaccines, the development paradigm became more important and the two approa ches were more in balance. However, since the reports about effective treat ment of AIDS and hope of development of vaccines, the biomedical paradigm h as become a leading principle in many HIV/AIDS prevention programmes. There is a need for a better balance between the two paradigms. Especially in de veloping countries, where it is not realistic to think that sustainable bio medical interventions can be organized on a short-term basis, it would be c ounterproductive to base our efforts to deal with HIV/AIDS exclusively on t he biomedical approach.