Psychology 2075 Chapter Notes - Chapter 16: Aids, Immunodeficiency, Meta-Analysis

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Week 16
AIDS Exceptionalism: On the Social Psychology of HIV
Prevention Research
Simian immunodeficiency virus is the probable source of HIV
o Appears to have crossed from primates to humans in west and central
Africa
o Between 1910 and 1950
Spread from Africa to North America via Haiti
Widespread behaviorally driven infection: having sex with men; injection
drug users
Become visible on June 15, 1981, with the publication of a brief article in
Morbidity and Mortality Weekly Report
September 1982, the Centers for Disease Control and Prevention
Had identified the disease as acquired immunodeficiency syndrome and
labeled it AIDS
Biomedical discoveries occurred at a rapid pace after the clinical recognition
of AIDS
Blood test to identify antibodies to HIV was achieved by 1985
1983 - first reports of infection of female partners of men with AIDS
Mid-1980s - development of AZT (drug) that prevented maternal-fetal
transmission of HIV
HIV transmission rarely took place is the couple used condoms
Characteristics that included homosexual orientation, intravenous drug use,
poverty, racism, and fear of contagion led to stigma and rejection of people
with AIDS and institutional isolation of the health care providers who were
struggling to treat them
AIDS self-help groups emerged
Extreme views were not uncommon during this difficult time
AIDS doctors active during the first decade of the epidemic were
o Young and white
o Half were Jewish
o 40% gay or lesbian
o 30% women
Mid-1980s - testing + for HIV proved catastrophic and deathly
1980s - global mobilization against the disease took place, as well as world-
wide prevention
1986 - UN World Health Organization established a global AIDS program
1996 - International AIDS Conference held in Vancouver welcomed
announcement of the success of antiretroviral therapies that slowed or
stopped viral replication and dramatically changed HIV infection from a
nearly always fatal disease into a manageable chronic condition
The current state of the global HIV/AIDS epidemic is defined by…
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o The availability (or unavailability) of antiretroviral therapy
o Differential patterns of infection among men who have sex with men
o Intravenous drug users
o Heterosexual individuals (in the West) and among heterosexual
individuals and via perinatal transmission (in Africa and the
developing world)
Social and behavioral scientists have been heavily involved in responding to
each stage of the HIV epidemic
HIV Exceptionalism: Public Health Policy and Efforts to Contain the HIV
Pandemic
The assertion that HIV exceptionalism characterized prevention research
and practice across the epidemic and had unintended but significant negative
effects on individual and public health is reviewed in the discussion that
follow
Public health practice places a high priority on the identification of infected
individuals
o Via screening and testing
o Notifying partners of infected individuals
Preventive behavior can also help HIV+ individuals avoid contracting other
Pathogens themselves through risky sexual behavior or intravenous drug use
and further compromising their health
In an epidemic context that was the embodiment of prejudice and
stigmatization of those with HIV/AIDS, more weight was accorded to
protection of individual privacy and individual rights than to protection of
public health
The history of what has been referred to as HIV exceptionalism in public
health efforts to contain the epidemic, like the history of the epidemic itself,
Has been described as involving a sequence of eras, including the emergence
of…
o Exceptionalism (19811985)
o The consolidation and consistent practice of exceptionalism (1986
1991)
o The crumbling of hegemonic exceptionalism (19911996)
o Normalization of public health approaches to HIV (1996present)
Advocates of normalization in HIV prevention have as- serted
that HIV exceptionalism has lost its legitimacy in the era of
effective treatment for HIV infection, since failure to identify
HIV infected individuals though routine screening eliminates
access to effective treat- ment for those infected as well as
posing a public health challenge
HIV Exceptionalism in Prevention Research in the Social Sciences
HIV exceptionalism has characterized HIV prevention research in the social
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sciences
Historically focused on the development, implementation, and evaluation of
HIV prevention interventions without specific focus on the prevention needs
of HIV+ individuals
It is the case that hundreds of single studies and well over a dozen meta-
analytic reviews of HIV prevention interventions, directed at populations
selected for characteristics other than HIV infection status, have been
published over the course of the epidemic
Early in the HIV epidemic, it would have been possible to develop and
deploy theory-based and empirically validated interventions to support
preventive behavior among individuals who became aware that they were
HIV+ and capable of transmitting infection to others
Antiretroviral therapy has made the illness more manageable
From a public health perspective, there is the challenge of a growing
population of relatively healthy HIV+ individuals who comprise an
increasing number of potential vectors of infection
HIV infected individuals clearly deserve effective prevention support based
on the best theoretical and empirical efforts of the social and behavioral
sciences
Established the following rational basis for HIV prevention interventions for
HIV-infected individuals, or what is now termed Prevention for Positives:
1. All new HIV infections begin with an HIV infected person and some
HIV+ individuals who are aware of their status nevertheless engage
in transmission risk behavior
2. It is more efficient to intervene with the small minority of persons
who are HIV+ than with the general public, although both
intervention approaches remain important
3. HIV prevention interventions with HIV+ persons can be successful in
reducing transmission risk behavior
4. In the era of antiretroviral therapy, prevalence rates for HIV
infection will continue to increase as will the number of persons
capable of transmitting infection
5. In the era of antiretroviral therapy, imperfect adherence and other
causes will result in the development of drug resistant HIV which
may be transmitted to uninfected others and which amplifies the
public health importance of prevention for positives
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