Handbook of Psychology

Primary Prevention 221

at a total cost, it would also be necessary to add in the lost
economic opportunities associated with young workers.

Summary

HIV disease is now considered a worldwide pandemic. Trans-
mission of HIV through transfer of infected blood, semen,
vaginal secretions, and breast milk is well-understood, and
the path from infection with HIV to diagnosis with AIDS fol-
lows a known pathophysiological course. The psychosocial
impact of HIV/AIDS is dif“cult to overstate, with dramatic
implications for the infected person and her or his loved ones.
Because HIV is disproportionately a disease of young adults,
its economic impact includes lessened productivity and in-
creased child care costs as well as costs associated with med-
ical care.

PRIMARY PREVENTION

Primary prevention refers to the protection of health by per-
sonal as well as community-wide efforts (Last, 1995). A com-
prehensive approach to the primary prevention of HIV disease
requires biological, psychological, and social interventions.
As depicted in Figure 10.1, complementary interventions
would direct disease prevention efforts toward different tar-
gets, such as the cell or other biological systems, the individ-
ual or couple, or communities or larger social structures that

in”uence the likelihood of disease transmission. Psycholo-

gists will remain active in most of these levels of prevention.

For example, when a vaccine is developed, psychologists will

play an important role in developing delivery and adherence

strategies to facilitate the vaccine•s rapid, safe, and effective

deployment (Hays & Kegeles, 1999; Koblin et al., 1998).

However, because a vaccine is not yet available„and one may

not be ready for many years„prevention of new infections

through behavior change provides the most prudent, practical,

and affordable public health strategy. Therefore, in this sec-

tion, we review interventions that have been implemented to

reduce the risk of HIV transmission through changes in sexual

behavior or drug use. We focus on important early studies, and

recent studies that illustrate promising developments.

The literature on primary prevention interventions can be

organized in several ways. First, we might organize it based on

whether the intervention is designed to reduce HIV transmis-

sion through sexual behavior change or through reduction of

needle sharing. Sometimes, however, these two intervention

targets overlap, as with risk reduction efforts among sexually

active, injection drug users. Second, prevention interventions

might be distinguished by demographic, developmental, or

behavioral characteristics of the population being served (e.g.,

men or women, adolescents or adults, gay or straight).

A third way to distinguish prevention interventions is with

respect to the setting in which they occur. In this chapter,

we use McKinlay•s (1995) conceptual framework, which

Proximity to

Target

Public Policy

Social Diffusion of Norms

Risk Reduction Programs

Microbicides

and Virocides

Vaccines Counseling and Testing

Target of

Intervention

Cell Systems Individual Couple Family Community Culture Nation

Basic Academic

Discipline

BIO PSYCHO SOCIAL

Figure 10.1 Complementary foci for HIV prevention.