Handbook of Psychology

238 AIDS/HIV

and intimacy. Such models will also re”ect greater sensitivity
to developmental, gender, and cultural considerations, and
will guide the development of new intervention approaches.

Refined Assessment and Data Analysis

A continuing challenge will be how tomeasurerisk behav-
ior because self-report can be compromised by memory
problems and demand characteristics. Investigators will
need to re“ne existing measures, and identify a • gold stan-
dardŽ to establish the accuracy of self-report measures. For
example, future efforts will likely try to demonstrate an em-
pirical link between self-reported behavior change and ap-
propriate biological markers (e.g., incident STDs). We also
expect greater use of biological markers to determine the ef-
fectiveness of prevention programs. Also, because sexual
and drug use behavior are notoriously dif“cult toanalyze,
health psychologists, working with behavioral- and biosta-
tisticians, will develop and use data analytic approaches
that are more appropriate to highly skewed count data that
are common in risk behavior research (Schroder, Carey, &
Vanable, in press).

Increased Use of Technology

Prevention programs will bene“t from technological ad-
vances. As mentioned earlier, technology will be used to en-
hance ef“ciencies in traditional health care settings through
computer-assisted screening, assessment, and patient educa-
tion. The internet will be used to enhance access to HIV-
related educational materials, social support, and medical
care, especially to persons who have traditionally been iso-
lated from such resources. We expect this to occur among
geographically isolated persons but we also hope that this
extends to the urban poor and to persons living in the devel-
oping world.

Sophisticated School-Based Programs

Given the rising salience of sexuality in all media (e.g., music
television, motion pictures) and increasing reliance on sci-
ence to guide policy making, we anticipate greater accep-
tance of science-based, sexual health curricula in public
schools. We expect that this development will reduce the in-
cidence of unintended pregnancies, HIV, and other STDs
among adolescents and young adults.

Evaluation Will Improve

Although most published studies of prevention trials in top-
tier journals have used control groups, often these have been

•no-treatmentŽ or •standard careŽ controls. We anticipate the

use of stronger control groups (e.g., alternative HIV preven-

tion programs), and greater use of components-analyzes and

other “ne-grained approaches to identify the most important

components of effective interventions. Intervention research

is also likely to employ longer follow-up evaluations, and to

develop strategies that facilitate the long-term maintenance

of the gains resulting from intensive risk reduction programs.

The value of booster sessions, supplemental interventions,

and media campaigns to establish norms supportive of be-

havior change will be studied further.

We expect that the reporting of intervention trials will con-

tinue to improve. For example, investigators will be required to

report effect sizes as well as inferential statistics to gauge the

magnitude of change and to re”ect •clinicalŽ as well as statis-

tical signi“cance. There will be increasing attention paid to the

cost-effectiveness of interventions (e.g., Holtgrave, 1998).

HIV-Positive Persons Will Receive Greater Attention

There will be efforts to develop more effective secondary pre-

vention programs for HIV-positive persons. As the number of

persons living with HIV continues to grow, there will be

tremendous opportunities for health psychologists to play an

important role in improving the lives of persons living with

HIV. Within HIV care settings, health psychologists will

increasingly be called upon to provide direct services and

consultation directed toward improving patient adherence to

complex treatment regimens and helping patients to adapt to the

many stressors associated with HIV disease. Behavioral scien-

tists will also increasingly be called upon to provide effective

interventions to reduce high-risk sexual and drug use practices

among HIV-infected men and women. Secondary prevention

research has been slow to develop relative to the advances seen

in the area of HIV primary prevention. Nonetheless, the need

for empirically validated intervention approaches for HIV-pos-

itive individuals must be balanced with the immediate urgency

of implementing clinic-based interventions with HIV-positive

individuals already in treatment and known to be struggling

with behavioral issues such as adherence or sexual risk. With in-

creasing research funding now being directed toward the devel-

opment of innovative behavioral intervention approaches for

HIV-positive men and women, we are optimistic that many in-

novations in secondary prevention will be reported and dissem-

inated in the very near future.

Upstream Interventions Will Become More Common

An important challenge, especially for primary prevention,

is the need to develop, implement, and evaluate upstream