Handbook of Psychology

CHAPTER 10

AIDS/HIV

MICHAEL P. CAREY AND PETER A. VANABLE

219

BASIC INFORMATION ABOUT HIV DISEASE 219
Epidemiology 219
Transmission and Natural Course 220
Psychosocial and Economic Impact 220
Summary 221
PRIMARY PREVENTIO219N 221
Downstream Approaches 222
Midstream Approaches 224
Upstream Approaches 229

SECONDARY PREVENTION 230

Historical and Psychosocial Context of HIV

Medical Care 230

Critical Issues in Secondary Prevention 231

Risk-Reduction among Persons Living with HIV 235

FUTURE DIRECTIONS 237

Continuing Challenges and Future Directions 237

CLOSING COMMENTS 239

REFERENCES 239

In the 1970s and early 1980s, health psychologists suggested
that we could turn our full attention to the chronic illnesses
because the infectious diseases that had plagued human exis-
tence for millennia had been conquered. Within a few short
years of such optimistic (and perhaps somewhat naïve) state-
ments, however, the human immunode“ciency virus (HIV)
and the resulting acquired immunode“ciency syndrome
(AIDS) was identi“ed and a pandemic of historic proportions
began to unfold. Indeed, in some African countries, life ex-
pectancy has dropped to levels not seen since the Middle
Ages; for example, in Botswana, life expectancy is expected
to drop from 66 to 33 years (Brown, 2000). Today, HIV/
AIDS is recognized as one of the most important health
threats we face.
Health psychologists have and will continue to play many
important roles in efforts to prevent HIV infection, facilitate
adjustment to HIV disease, and treat AIDS. Therefore, in this
chapter, we review basic information about HIV disease
including its epidemiology, transmission, natural course,
treatment, and psychosocial and economic effects. Although
health psychologists have conducted extensive basic re-
search regarding psychosocial aspects of HIV/AIDS (e.g.,
the effects of stigmatization and prejudice; Herek, 1999), we
devote our chapter to reviewing appliedresearch. First, we
review primary prevention interventions that have been im-
plemented to reduce transmission of HIV. Our review focuses
on research conducted in the United States, but includes “nd-
ings from international trials where available. Second, we

review secondary prevention approaches designed to help al-

ready infected persons cope with the psychosocial challenges

that HIV disease brings, adhere to treatment regimens, and

avoid reinfection with HIV. Finally, we conclude the chapter

by identifying important research needs and outline our ex-

pectations regarding future developments. We hope that this

information helps health psychologists continue to make im-

portant contributions to the prevention and treatment of HIV.

BASIC INFORMATION ABOUT HIV DISEASE

In this section, we provide basic information about the epi-

demiology, transmission, natural course, treatment, and psy-

chosocial and economic effects of HIV disease.

Epidemiology

HIV/AIDS no longer occupies the public consciousness in the

United States the way it did in the mid-1980s, but it continues

to threaten public health in historical proportion. In the United

States, 733,374 cases of AIDS have been reported to the Cen-

ters for Disease Control and Prevention (CDC) by the end of

1999. The majority (82%) of the cases have been among men.
      Nearly one-half (47%) of AIDS cases have been among
      men who have sex with men (MSM), 25% in injection drug
      users, 10% in persons infected heterosexually, and 2% in per-
      sons infected through blood or blood products. Although the