AIDS. health concern. As of 2005, a cure for HIV/AIDS remains to be found. While medical

Transcription

1 AIDS As we move forward in the 21 st century, the HIV/AIDS epidemic remains a major public health concern. As of 2005, a cure for HIV/AIDS remains to be found. While medical researchers focus their efforts on finding a cure and preventative vaccine, social scientists work hard to find ways to prevent the spread of HIV/AIDS. These efforts have emphasized reducing behaviors that increase risk of exposure to HIV, such as having unprotected vaginal or anal sex and sharing injection drug needles. Doing so requires an understanding of which groups of people are most at risk. During the late 1990 s and early 2000 s, the Centers for Disease Control and Prevention (CDC) estimate 40,000 new cases of HIV each year in the United States. Among 23,153 of the men diagnosed with HIV in 2003 (73% of all cases reported by 33 states), men who have sex with men (MSM) accounted for the largest proportion (63%), followed by heterosexual contact (17%), and injection drug use (14%). Among women diagnosed with HIV in 2003 (27% of all cases), heterosexual contact accounted for the largest proportion (79%), followed by injection drug use (19%). While a much higher percentage of men are infected with HIV, women have become an increasingly larger percentage of those living with HIV/AIDS (increasing from 14% in 1992 to 22% in 2003) and heterosexual transmission has become an increasingly important factor for men. Race/ethnicity diagnoses in 2003 were disproportionately led by African Americans (50%), followed by Whites (32%) and Hispanics (15%). Social scientists use demographic information of groups at risk for HIV/AIDS to design and implement prevention programs specifically tailored to minimize exposure for that population. Because each population is primarily at risk through a single, but unique means of HIV/AIDS transmission, prevention programs vary tremendously in both target population and

2 emphasis. Identifying and effectively targeting those at risk for HIV/AIDS are fundamental to setting up a situation in which social prevention programs can be efficacious. The late 1900 s and early 2000 s have seen a variety of prevention programs, ranging from intense, individual therapy to group programs to public announcements addressing a large audience. Three primary components of prevention programs appear most effective: providing attitudinal arguments, basic information, and behavioral skills training. Although attitudes do not always predict behavior, research has shown that that certain attitudes can influence the likelihood one engages in a certain behavior. For example, positive attitudes toward condoms are associated with more frequent condom use. Basic information made available in prevention programs typically includes discussions of how the virus is transmitted, how to evaluate personal level of risk exposure, and how to prevent transmission. Behavioral skills training allows participants to practice various skills related to reducing high risk sexual behavior. Training can include skills such as discussing condom use with partners, condom application and removal, and cleaning and disinfecting needles and syringes. Although attitudinal arguments, basic information, and behavioral skills training are common components of effective prevention programs, an individual s gender, ethnicity, age, and risk group impacts the extent of that effectiveness. Other prevention approaches have experienced varied results. Programs providing only basic information have little impact on reducing risky behaviors. Fear-based approaches most often target mass audiences, but are only effective if an individual believes he/she can do the desired behavior, and that if he/she does the behavior, it will lead to the expected outcome. That is, for condom use, fear-appeals work only when the person believes they can use condoms and that, if they do, they won t get HIV/AIDS.

3 There are several barriers to HIV/AIDS prevention efforts. These barriers include, but are not limited to, religious objections to sex education, substance use, unknown HIV status, underestimating risk, denial of sexual preference, sexual inequality in relationships, and AIDS stigma. Despite the extremely low rates of HIV/AIDS in countries with rigorous sex education programs, such as Holland and Sweden, religious-based objections to sex education remains an obstacle for prevention researchers. Those under the influence of alcohol or drugs are more likely to engage in high-risk behaviors such as unprotected sexual intercourse. An additional factor in the spread of HIV is the estimated 250,000 people living with HIV/AIDS in the United States who are un-aware of their status. Research in the 2000 s has shown that a high percentage of those testing positive for HIV consider themselves at low-risk for the virus. This is problematic as those who underestimate their risk of infection are less likely to engage in riskpreventing behaviors. Similarly, and particularly among African American MSM, denial of sexual preference is high. In addition to underestimating risk, these men are less likely to respond to, and thus benefit from, prevention efforts targeting MSM. Among women, perceived inequality in a relationship can reduce prevention efforts. For example, some women may fear violence or abandonment should they insist their partners use condoms. Perhaps the strongest barrier to prevention efforts comes from AIDS Panic, or AIDS stigma. There are three primary sources of AIDS stigma: Fear of HIV infection, labeling risk groups (i.e., identifying AIDS as a gay disease ), and negative attitudes toward death and dying. In addition to implementing programs aimed at reducing risky behavior, social scientists also work to eliminate stigmas associated with HIV/AIDS. By 2005, there is some evidence of positive effects from these programs; however, research in this area is limited, and the observed effects seem small and short-lived. Nonetheless, continuing these efforts is important because of

4 the severe negative effects stigma can have on those living with HIV/AIDS. These effects include psychological problems, such as anxiety and depression, strained social relationships, abandonment by family members, health effects, such as loss of medical insurance, and employment discrimination. Although most barriers to prevention are widespread, internationally, the AIDS epidemic is even more troubling and the additional barriers to prevention in Africa, Asia, and third-world countries have elevated the challenges facing prevention researchers. One s religious beliefs may discourage the use of condoms for contraceptive reasons. Poor economic conditions and access to medical care or antiviral medications coupled with even greater social stigma associated with the virus decrease the likelihood of persons living with HIV/AIDS seeking and receiving medical treatment. The 21 st century is marked by a global effort to help countries where HIV/AIDS cases are alarmingly high yet medical resources are scarce. In the absence of a vaccine, social science offers the only effective means of preventing HIV/AIDS transmission. The 1900 s and early 2000 s have seen great advancements in the effectiveness of prevention programs, especially those targeting specific high-risk groups. Despite these efforts, however, HIV/AIDS remains an international epidemic requiring an international response. Word Count: 1,093

5 Bibliography Albarracin, Dolores, Jeffery C. Gillette, Allison N. Earl, Laura R. Glasman, Marta R. Durantini, and Moon-Ho Ho A Test of Major Assumptions about Behavior Change: A Comprehensive Look at the Effects of Passive and Active HIV-Prevention Interventions Since the Beginning of the Epidemic. Psychological Bulletin 131 (6): Brigham, Thomas A., Patricia Donohoe, Bo James Gilbert, Nancy Thomas, Sarah Zemke, Darelle Koonce, and Patricia Horn. (2002). Psychology and AIDS education: Reducing high-risk sexual behavior. Behavior and Social Issues 12 (1): Brown, Lisanne, Kate Macintyre, and Lea Trujillo Interventions to Reduce HIV/AIDS Stigma: What have we Learned? AIDS Education and Prevention 15 (1): Centers for Disease Control and Prevention Website. Available from Contributors Dana F. Lindemann Department of Psychology Washington State University Thomas A. Brigham Professor and Scientist, Department of Psychology Washington State University