Handbook of Psychology

Future Directions 237

tion with other STDs). Although physicians are likely to
spend considerable time discussing the importance of consis-
tent medication adherence, care providers should arguably
direct equal attention to encouraging patients to avoid high-
risk sexual and drug use practices. Likewise, behavioral sci-
entists must devote increasing attention to the development
and dissemination of empirically validated risk reduction
interventions for HIV-infected persons. Multicomponent
interventions that meld psychosocial support, adherence, and
sexual risk reduction within HIV care settings may be a
particularly promising direction for future research.

FUTURE DIRECTIONS

The past decade has seen tremendous activity for health psy-
chologists who have conducted basic qualitative and correla-
tional research; developed and re“ned theoretical models of
risk behavior; and implemented and evaluated individual,
small group, and community-level interventions. In this
chapter, we focused our attention on applied research, specif-
ically on research evaluating behavioral interventions for the
primary and secondary prevention of HIV disease.
The intervention research has evaluated the effectiveness
of a variety of theory-based interventions with a wide range
of populations, including hard-to-access groups such as
homeless adults, runaway youth, IDUs, and the severely men-
tally ill. Many large RCTs have been completed, and allow
for strong inferences as they control for many threats to the
internal validity of intervention studies. These RCTs have in-
cluded multisite and international projects, which enhance the
external validity of the “ndings. Methodologically, the “eld of
psychosocial HIV/AIDS has advanced very quickly. More-
over, the research that has been completed has included un-
precedented collaboration among patients, community-based
advocates, and biomedical and social scientists.

Continuing Challenges and Future Directions

We expect that the impressive behavioral science commit-
ment to HIV/AIDS that we have witnessed in the past decade
will continue as health psychologists address a series of con-
tinuing challenges in research and practice. In this conclud-
ing section, we identify and discuss brie”y the continuing
challenges and future directions for research and practice re-
lated to HIV disease.

Integration of Biopsychosocial Approaches

We expect continued research to develop safe and effective
vaccines and microbicides to prevent infection. This research

and the deployment of such biological prevention strategies

will bene“t from involvement of health psychologists to de-

velop acceptable distribution and adherence strategies, and

address beliefs and fears regarding the common perception

that governments and scientists cannot be trusted. We also

expect continued collaboration among biomedical and be-

havioral scientists and practitioners in the prevention and

treatment of HIV disease.

We expect that greater use will be made of the teachable

moments that occur in HIV C&T, STD, and primary care set-

tings. In such settings, we expect increased use of brief

screening measures (e.g., Gerbert et al., 1998) and time-

limited interventions (Boekeloo et al., 1999; Kalichman,

1996). Advances in computer technology will make it easier

for practitioners to offer such screening, and to make avail-

able brief, of“ce-based interventions that require little pro-

fessional time (through videotape, CD-ROM, DVD, and

emerging technologies). Screening will also identify persons

at high risk who are most likely to bene“t from more inten-

sive, face-to-face interventions that can be delivered by peer

educators and health care providers. Such a system will be

more accessible, affordable, and con“dential, and increase

the reach of such down- and midstream approaches.

Continued Collaboration with Community Leaders

The involvement of community leaders has been essential to

the development and implementation of HIV interventions.

Collaboration among community groups, practitioners, and

scientists will continue. Community-based and other •grass

rootsŽ groups will increasingly demand a more powerful

voice in planning and decision making regarding prevention

and treatment trials. Community-based groups and health

professionals need to continue what has been a productive

and mutually rewarding relationship to disseminate effective

interventions to community-based organizations (i.e., •tech-

nology transferŽ). Health psychologists will seek to develop

more effective and ef“cient methods of technology transfer

(Kelly, Sogolow, & Neumann, 2000). There will be increased

study of the problem of retaining participants in interventions

without the use of incentives.

Development of New Intervention Models

We expect to see continued development of new intervention

models, including brief interventions that target the theorized

determinants of risk behavior change in the most direct and ef-

“cient manner. We also anticipate the development and re“ne-

ment of theoretical models of HIV-related risk behaviors that

attend more to interpersonal relationships, human sexuality,