[Participatory Quality Development: Engaging Community Members in All Phases of Project Planning and Implementation]. / Partizipative Qualitätsentwicklung: Zielgruppen in alle Phasen der Projektgestaltung einbeziehen.

Community participation, recognised as a central feature of successful health promotion and prevention, is often difficult to implement. In this research project internationally recognised methods of participatory health research were applied to demonstrate ways in which community members can be engaged. Participatory health research is characterised by a close collaboration between academic researchers, practitioners and community members in order to generate common knowledge. It is not a question of translating knowledge from research into practice, but rather a question of promoting a collective learning process on the part of all participants for the purpose of developing solutions which address the interests and needs of local people. The result of the project is a new approach for strengthening the quality of prevention and health promotion interventions: participatory quality development (PQD).

[AIDS. New challenges for social and medical prevention]. / Aids. Neue Herausforderungen für die soziale und medizinische Prävention.

Anti-retroviral therapy (ART) produces spectacular improvements in life expectancy and quality of life for people infected with HIV, and contributes to primary prevention in the wider population by reducing the viral load. Many people infected with HIV begin therapy later than indicated, while, despite ongoing prevention efforts, the number of new HIV diagnoses is increasing, along with the incidence of other STIs and, in identifiable sub-groups, of hepatitis C, above all among men who have sex with men (MSM). The prevention consequences of this complex situation are discussed in the context of the alternative between control and containment (Suchstrategie) and inclusion and cooperation (Lernstrategie), arguing for HIV prevention to be integrated in the broader paradigm of sexual health and sub-group-specific efforts to increase the willingness to undergo testing both through community-based campaigns and in the health care context on the basis of informed consent and counseling. Above all ethical considerations mitigate against an undifferentiated test-and-treat approach. The contribution identifies research gaps and institutional obstacles that stand in the way of achievable advances and productive linkage of social and medical prevention.

[AIDS prevention in Germany - a successful model in crisis]. / AIDS-Prävention - ein Erfolgsmodell in der Krise.

The rising number of new HIV infections in Germany, particularly among men who have sex with men, raises the question whether the previously successful prevention strategy should be revised. This strategy has been based on a New Public Health approach which arose from the specific historical context in Europe at the start of the epidemic. The hallmarks of this approach are: the active involvement of the target groups; the central role of non-governmental organizations; the combination of population level and targeted, context specific interventions; and an emphasis on social integration and voluntary participation in the work with target group members. Current challenges include: changes in risk perception (at least in part due to the availability of more effective treatments); a diversification of prevention behavioral strategies among target group members; the formation of new sexual subcultures and target groups; as well as changes in hard-to-reach populations such as immigrants and people of lower socioeconomic status. In order to meet these challenges the following measures are necessary: an increased investment in prevention research (with a particular focus on interventions specific to social contexts in which risk behavior is increasing); further development of the institutional infrastructure for prevention, including the full implementation of UNAIDS guidelines for national prevention strategies; and improving the prevention work of local AIDS service organizations and public health authorities through an increase in funding and the implementation of quality assurance measures based on participatory action research.

[Health and justice in Germany]. / Gesundheit und Gerechtigkeit in Deutschland.

"What do we owe each other?" Variously grounded postulates and theories of social justice try to answer this question with regard to health. Equality of opportunity is widely acclaimed and in Germany also anchored in social security laws. From the perspective of equal opportunity, the author examines the state of affairs and the perspectives of equity in health. Although the deficiencies with regard to access and quality of health care are significant, but relatively moderate, they present serious threats to equity and fairness for the future. Regarding non-medical primary prevention, the reduction of inequality in health has barely begun. The largest obstacles to equity in health are to be found in the distribution and dynamics of opportunities for education, work and income. One of the tasks of public health professionals is to place the health consequences of existing policies on the political agenda.

[Primary prevention and health promotion--health science fundamentals for health policy]. / Prävention und Gesundheitsförderung - gesundheitswissenschaftliche Grundlagen für die Politik.

There is a broad health policy consensus about the necessity of augmenting and improving primary prevention. To be successful, the current initiatives need to be supported by concepts, categories and classifications, meeting the criteria of logical consistency, political consensus and suitability for administration. This survey paper presents suggestions regarding to the relationship between primary prevention and health promotion, for the definition of different levels and starting-points of primary prevention as well as to concepts of evaluation and quality assurance.

The normalization of AIDS in Western European countries.

The occurrence of AIDS led in every Western European country to exceptional innovations in prevention, patient care, health policy and questions of civil rights. This exception can be explained above all by the fact that not only was a health catastrophe feared but also civilizational harm in the field of civil rights. Despite national differences, this brought about similar exceptionalist alliances consisting of health professionals, social movements and those affected. With the failure of a catastrophe to arise, signs of fatigue in the exceptionalist alliance and increasing possibilities of medical treatment, exceptionalism in Europe is drawing to a close. Four phases are distinguished between in this process, given nationally different patterns of development: Approx. 1981-1985: emergence of exceptionalism. The reasons underlying exceptionalism are investigated. Approx. 1986-1991: consolidation and performance of exceptionalism. The investigation centers on the exceptionalist policy model. Approx. 1991-1996: exceptionalism crumbling, steps toward normalization. The forces driving the process of normalization are investigated. Since 1996: normalization, normality. The forms and perspectives of the changes made in the management of HIV and AIDS are elucidated using examples from the fields of health care, primary prevention and drug policies. AIDS health-policy innovations, their risks and opportunities in the course of normalization are investigated. Three possible paths of development are identified: stabilization, generalization and retreat. The chances of utilizing innovations developed in connection with AIDS for the modernization of health policy in other fields of prevention and patient care vary from country to country with the degree to which AIDS exceptionalism has been institutionalized and the distance of these innovations from medical, therapeutic events.

[Community nursing from the viewpoint of public health]. / Gemeindenahe Pflege aus der Sicht von Public Health.

Findings of health science as to the incidence and dynamics of health problems and the knowledge to optimize health promotion, prevention and patient treatment as well as international comparisons indicate that the potentials of nursing--understood as a system of nurses, nursing institutions and nursing science differentiated in itself--are not exhausted to their full extent within the German system of social health assurance. Following the introductory reflections on the relation between public health and nursing, being relatively young multi-disciplines of health science in Germany, this paper tries to identify and to describe the related deficiencies and approaches for their rectification by means of the four phases of the Public Health Action Cycle--assessment: of problems and fixing of priorities; policy formulation: selection, negotiation and fixing of strategies; assurance: organisation, implementation and control as well as evaluation: evaluation of the strategy and its results. This paper is the revised version of the basic lecture that the author gave on the occasion of the Fourth International Symposium of Nursing Science in Osnabrück in November 1996.

[Health promotion in the work environment--old and new challenges for public health]. / Gesundheitsförderung in der Arbeitswelt--alte und neue Herausforderungen für Public Health.

Associations between work and health can be found at many different levels. Work itself can have health hazardous as well as health promoting effects. Work defines status and life-style as well as social security and occupies a large proportion of time in our lives. Until now the process to integrate issues of worksite prevention and health promotion into Public Health proceeds slowly in contrast to other countries e.g. the USA. Weak connections between occupational medicine and Public Health as well as relative few projects focussing on work site in the Public Health Research Associations reflect this trend. Work site public health research according to the guidelines of the Ottawa Charta (WHO) could enhance the transition of approaches justified now in terms of risk and legal liability towards an orientation on health resources and preventive potentials. This transition is promising in regard to the science of public health. However, bottleneck facilities can be identified: the development of appropriate health reports in companies, the implementation and further development of new steering models for worksite interventions (especially the organizational development) and the implementation and further development of appropriate form of quality assurance which can be evaluated.

[Public health as a social innovation]. / Public Health als soziale Innovation.

Public Health is a social innovation of the modes how society deals with health risks before and after their occurrence. In this paper the essence of this innovation is sketched out with regard to the four stages of the Public Health Action Cycle (assessment, policy formulation, assurance, evaluation). Based on both literature surveys and own research findings several critical aspects of innovation are identified at each of these stages. At present, the bottle-neck of the intended social innovation seems to be the implementation, stabilisation, and generalisation of interventions.

Screening for human immunodeficiency virus.

Screening for human immunodeficiency virus (HIV) antibodies as a means of preventing both the progress and spread of acquired immunodeficiency syndrome (AIDS) is problematic in terms of efficacy, effectiveness, and ethics. The few desired effects are mostly offset by greater and more certain undesirable effects on individuals and society.

Some social and health policy requirements for the prevention of AIDS.

Given the present circumstances and considering the foreseeable development of medical knowledge, the primary prevention of AIDS is the sole field of health policy in which the spreading of the disease and the subsequent number of victims can be reduced. AIDS prevention as a time-stable behaviour control in potentially risky situations is therefore primarily a task which has to be tackled in a social scientific manner. It has to be handled on the basis of available medical knowledge of infectious disease situations. Viewed realistically, the prospective goal is not the elimination of the disease, but the greatest possible reduction and minimization of risk, both individually and epidemiologically. Proceeding from realistic estimates of the desired and undesired effects of health policy measures, this principle is being applied through the strategy (achieved through informational campaigns) of encouraging the use of condoms when having sexual intercourse in non-monogamous relationships and of informing intravenous drug abusers of the need to employ sterile hypodermic needles. Elements of this preventive strategy are discussed under four central questions: What should/must be learn? Who should/must learn? What objective and subjective factors facilitate or hinder this learning? How can this learning process most optimally be organized? The efficiency-reducing interference of other kinds of strategies (e.g. orientation toward zero risk concepts, repression, and mass screening for HIV-anti-bodies) is thereby worked out.