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AIDS Exceptionalism Article Notes.docx

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Department
Psychology
Course
Psychology 2075
Professor
William Fisher
Semester
Spring

Description
AIDS Exceptionalism: On the Social Psychology of HIV Prevention Research • first 2 decades of HIV epidemic, social scientists conducting HIV prevention research focused on promotion of preventive behaviour among o members of general public o members of so-called “high risk groups” = without ref to HIV – or HIV+ status of target populations • AIDS Exceptionalism – departures from standard public health practice and prevention research priorities in favor of alternative approaches to prevention that, it has been argued, emphasize individual rights at expensive of public health protection The Context: A Brief History of HIV Epidemic • initial stage of AIDS epidemic = “silent spread” of HIV • Hahn & Colleagues o simian immunodeficiency virus = probable source of HIV, crossed from primates to humans  in west and central Africa multiple times b/w 1910-1950 o HIV-like virus infection detected in humans in central AfricaHaitiNA • 1970s – behaviourally driven infection among men sex w/ men, injection drug users • 1981 – Morbidity and Mortality Weekly Report o AIDS epidemic begins to become visible o 5 homosexual men – unusual opportunistic infections • 1982 – Centers for Disease Control and Prevention o acquired immunodeficiency syndrome – AIDS • mid-1980s – identification of HIV as pathogen responsible for AIDS o 1985 – blood test identify antibodies to HIV that indicate infection with virus o 1983 – infection of female partners of men with AIDS o development of drug AZT  prevent maternal-fetal transmission of HIV  treatment for AIDS – failed to be effective, o condoms – prevented transmission • era of therapeutic impotence – no treatment for AIDS, people dying • Bayer & Oppenheimer’s sizable social history sample of AIDS doctors active during first decade of epidemic was o young and white, 1/2 Jewish, 40% gay/lesbian, 30% women • HIV prevention researchers were self-selected on basis of empathy, tolerance and liberal values • Project SIDA – early example of international efforts to address AIDS on African Continent in Zaire (1983) • 33 million children and adults living with HIV/AIDS worldwide o major centers of epidemic in North America, Latin America, South and Southeast Asia, sub-Saharan Africa • # people living with HIV/AIDS increasing – new HIV infections + decreases in AIDS mortality (anti-retroviral therapy) o uneven availability of antiretroviral therapy = 2.1 million adults and children die of HIV/AIDS (2007) • theoretical and empirical work in social and health psychology that preceded the HIV epidemic o including work on Theory of Reasoned Action, Theory of Planned Behaviour, Social-Cognitive Theory, the Transtheoretical Model and social influence and reference group theory  applied to HIV prevention efforts across the epidemic • current HIV prevention efforts o adherence to antiretroviral therapy + psychological interventions to promote adherence o address and support prevention needs of person living with HIV HIV Exceptionalism: Public Health Policy and Efforts to Contain the HIV Pandemic • standard public health practice for containing STI o places high priority on identification of infected individuals  via screening and testing, and notification of partners of infected individuals, so they seek testing themselves  affected individuals avoid transmitting infection o others o rapid and effective treatment of infected individuals and their contacts  not option until late in epidemic • an alternative open to all individuals - preemptive practice of prevention without necessity for HIV testing or learning one’s HIV status • approaches to HIV control during first decade of epidemic o some argue disease containment efficiency of nonexceptional implementation of standard public health practices – widespread testing and screening, safer sex counseling and partner notification  could have averted considerable infection and mortality • history of HIV Exceptionalism o emergence of Exceptionalism + consolidation and consistent practice of Exceptionalism o crumbling of hegemonic Exceptionalism o normalization of public health approaches to HIV prevention  advocates for normalization in HIV prevention said HIV Exceptionalism − lost legitimacy in effective treatment for HIV infection – failure to identify HIV infected ppl, no effective treatment HIV Exceptionalism in Prevention Research in the Social Sciences • focused on development, implementation and evaluation of HIV prevention interventions o w/o specific focus on prevention needs of HIV + individuals • HIV prevention intervention research for HIV + individuals came later in history of epidemic o 1998 – conference held, attention to risk behaviours among HIV infected persons as a “new issue” • # of HIV infected individuals increasing steadily b/c AIDS-related mortality decreased (antiretroviral therapy) o infectivity of HIV+ person on antiretroviral therapy lessened but HIV infected individuals deserve effective prevention support based on best theoretical and empirical efforts of social and behavioural sciences • established rational basis for HIV preventions for HIV infected individuals = Prevention for Positives o (1) all new HIV infections begin with HIV infected person and some HIV + individuals who are aware of their status nevertheless engage in transmission risk behaviour o (2) more efficient to intervene with small minority of HIV + than general public – even though both important o (3) HIV prevention interventions with HIV+ persons successful in reducing transmission risk behaviour o (4) in era of antiretroviral therapy – prevalence rates increase, # ppl capable of transmitting infection increase o (5) in era of antiretroviral therapy – imperfect adherence and other causes  result in development of drug resistant HIV – transmit to uninfected others  which amplifies public health importance of prevention for positives HIV Prevention Research in the Social Sciences • early in HIV epidemic = HIV prevention interventions targeted populations not known to have HIV infected individuals • conclude: Johnson et al. and Crepaz et al. reported meta-analytic evidence of intervention effectiveness with respect to HIV + ppl o rates of condom use or unprotected sex o & reported decreased acquisition of STI in HIV + intervention (vs. HIV + control) ppl • to gain broadest empirical overview of record of HIV prevention intervention research for HIV+ individuals, across epidemic o novel analysis of extensive database of Prevention Research Synthesis project of Centers for Disease Control and Prevention o included in analysis all HIV interventions, directed at any population , with any HIV prevention related end-point  HIV prevention information, motivation, HIV risk behaviour or acquisition of STI o eliminated studies without such end-points and studies after 2006 o most HIV prevention interventions  did not target HIV + individuals  did not provide info about HIV status of participants o very few prevention interventions  did not target HIV + individuals  did provide HIV status of participants o very few prevention interventions  target HIV + participants with any prevention-relevant endpoint o very few prevention interventions  target HIV + individuals capable of communic
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