NATIONAL HEALTH LINE

Building Capacity for Evidence We Can Believe In: The Argument for Social Change as an Evidence-Based Practice Agenda
DarrellP. Wheeler and Tyrone M. Parchment

espite medical and behavioral advancements in HIV/AIDS prevention and intervention, not all groups, here in the United States and globally, experience the advantages of scientific discoveries. In a climate that scrutinizes the use of limited resources and emphasizes increased practice efficacy, evidence-based practice (EBP) has become the cornerstone of many health and mental health programs. In HIV prevention and intervention work in particular, practitioners and interventionist are often required by funding mandates to draw from a limited set of EBP models or to justify alternatives using a standard of "promising" and evidence-based interventions (Seckinelgin,2007;Wheeler & Goodman, 2007). The complexities of working in the HIV/ AIDS arena in the United States are daunting, and the ways in which race, gender, ethnicity, economics, substance use, and so forth interact defy most efforts to develop compact and comprehensive HIV and AIDS prevention and intervention tools (Wheeler, 2007) .Yet as a nation we are publicly committed to reversing and ultimately eradicating HIV and AIDS here and throughout the world. Making this commitment a reality has been an elusive task and has netted many narrowly focused, if not short-sighted, intervention packages. Further complicating the application of EBP interventions is the lack of support for sustained implementation and capacity building and the limited (if present) capacity for these models to address basic human needs (for example, income, housing, employment) present in the lives of those who are most in need. Thus, the models and practices we bring to bear are often ill-equipped to address many of the root causes of social and health inequalities, including those contributing to HIV/AIDS. If this is under-

stood to be so, then developing alternative models of practice that incorporate social change and social justice is a requirement for truly effective evidencebased models and not just desired long-term outcomes. In this article, we take a critical look at one example of EBP and how its evidence base leads to both questions of veracity and opportunities for social workers to develop and implement models of practice that build on solid evidence.
EVIDENCE GONE AWRYEXAMPLE

In the summer of 2008, the U.S. Centers for Disease Control and Prevention (CDC) reported on new estimates of HIV prevalence that showed a 40 percent increase over prior estimates; in these revised estimates, more than 1 million adults are believed to be living with HIV infection in the United States. Furthermore, these revised estimates also report that African Americans and Hispanics/Latinos are the most heavily affected by HIV/AIDS. In the past, statistical evidence has justified the limited federal dollars and resources allocated to HIV and AIDS prevention, despite protests from community programmers and activists asking for more support. The report from the CDC explains in some detail the methods used for calculating the new estimates and the limitations associated with estimate calculations in general. In addition, the report highlights the need for better primary prevention, getting people tested, and getting newly infected individuals into care. The report provides a much clearer view of the current HIV epidemic in the United States, but it also raises a criticism echoed by community programmers and activistssurveillance data are not infallible and, in fact, can be misleading. This point is of vital significance when we consider how such estimates, are used in policy making and to allocate limited resources.

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Gredig, D., & Sommerfeld, P. (2008). New proposals for generating and exploiting solution-oriented knowledge. Research on Social Work Practice, 8, 292-300. MackenbachJ. P., Kunst, A. E., Cavelaars.A. E., Groenhof, E, & Geurts,J.J. (1997). Socioeconomic inequalities in morbidity and mortality in Western Europe. Lancet, 349, 1655-1659. Mullen, E. J., Bledsoe, S. E., & Bellamy,J. L. (2008). Implementing evidence-based social work practice. Research on Social Work Practice, 18, 325-338. Panzano, P., & Herman, L. (2005). Developing and sustaining evidence-based systems of mental health services. In R. E. Drake, M. R. Merrens, & D. Lynde (Bd.), Evidence-based mental health practice (pp. 167187). NewYork: W.W. Norton. Seckinelgin, H. (2007). Evidence-based policy for HIV/ AIDS interventions: Questions of external validity, or relevance for use. Development & Change, 38, 1219-1234. Wheeler, D. P (2007). HIV and AIDS today: Where is social work going? Health & Social Work, 32, 151-157. Wheeler, D. P, & Goodman, H. (2007). Health and mental health social workers need information literacy skills [National Health Line]. Health & Social Work, 32, 235-237. Darrell P. Wheeler, PhD, MPH, is associate professor and associate dean for Research and Community Partnerships, and Tyrone M. Parchment, AiSWf is research assistant. Hunter College School of Social Work, 129 East 79th Street, NewYork, NY 0075; e-mail: dwheeler@hunter.cuny.edu.

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WHEELER AND PARCHMENT / Building Capacity for Evidence We Can Believe In

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