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As the twenty-first century moves forward, the HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) epidemic remains a major public health concern. As of 2006, a cure for HIV/AIDS remained to be found. While medical researchers focus their efforts on finding a cure and a vaccine, social scientists work hard to find ways to prevent the spread of HIV/AIDS. These efforts have emphasized reducing behaviors that increase the risk of exposure to HIV, such as having unprotected vaginal or anal sex and sharing needles when injecting drugs. Such efforts require an understanding of which groups of people are most at risk for contracting HIV.
During the late 1990s and early 2000s, the Centers for Disease Control and Prevention (CDC) estimated that approximately forty thousand new cases of HIV infection occurred each year in the United States. Among the 23,153 men diagnosed with HIV in 2003 (73 percent of all cases reported by thirty-three states), men who have sex with men (MSM) accounted for the largest proportion (63%), followed by those reporting heterosexual contact (17%) or injection-drug use (14%), MSM and injectiondrug use (5%), and other-unspecified (1%). 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%), with 2% reported as other-unspecified. While a much higher percentage of men are infected with HIV in the United States, women make up a rising percentage of those living with HIV/AIDS (their numbers increasing from 14% in 1992 to 22 percent 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 to design and implement prevention programs specifically tailored to minimize exposure for population groups at risk for HIV/AIDS. Because each population is primarily at risk through a single but unique means of HIV/AIDS transmission, prevention programs vary tremendously in emphasis depending on the target population. Identifying and effectively targeting those at risk for HIV/AIDS are fundamental to setting up a situation in which social prevention programs can be effective. The late 1990s and early 2000s have seen a variety of prevention programs, ranging from intense, individual therapy to group programs and 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 certain attitudes can influence the likelihood that 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 one’s personal level of risk exposure, and how to prevent transmission. Behavioral skills training allows participants to practice 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 can have an impact on that effectiveness.
Other prevention approaches have produced 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 or she can accomplish the desired behavior and that doing so will lead to the expected outcome. With condom use, for example, fearbased appeals only work when people believe they can use condoms and that, if they do, they won’t get HIV/AIDS.
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 the Netherlands and Sweden, religiousbased objections to sex education remain an obstacle for prevention researchers. People 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 people living with HIV/AIDS who are unaware of their status, an estimated 250,000 people in the United States alone. Research has shown that a high percentage of those testing positive for HIV considered themselves at low risk for the virus. This is problematic because those who underestimate their risk of infection are less likely to engage in risk-preventing 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 that 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; the labeling of risk groups (e.g., 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 2006, there was some evidence of positive effects from these programs; however, research in this area is limited, and the observed effects may be minor and short-lived. Nonetheless, continuing these efforts is important because of 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, 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. A person’s religious beliefs may discourage the use of condoms for contraceptive reasons, for example. In some countries, poor economic conditions and access to medical care or antiviral medications, coupled with an even greater social stigma associated with the virus, decrease the likelihood of persons living with HIV/AIDS seeking and receiving medical treatment. The early twenty-first 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 1900s and early 2000s have seen great advances in the effectiveness of prevention programs, especially those targeting specific high-risk groups. Despite these efforts, HIV/AIDS remains an international epidemic requiring an international response.
- Albarracin, Dolores, Jeffery C. Gillette, Allison N. Earl, et al. 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): 856–897.
- Brigham, Thomas A., Patricia Donohoe, Bo James Gilbert, et al. 2002. Psychology and AIDS Education: Reducing High-risk Sexual Behavior. Behavior and Social Issues 12 (1): 10–18.
- Brown, Lisanne, Kate Macintyre, and Lea Trujillo. 2003. Interventions to Reduce HIV/AIDS Stigma: What Have We Learned? AIDS Education and Prevention 15 (1): 49–69.
- Centers for Disease Control and Prevention. HIV/AIDS Prevention. http://www.cdc.gov/hiv/dhap.htm.
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