Aids Prevention and Mental Health – serie

Methodological problems have hampered researchers' efforts to understand and control AIDS since the beginning of the epidemic. This practical book addresses these problems by using actual health research case studies to develop strategies regarding design and sampling, measurement, and analysis and modeling issues. Researchers working on both biological and behavioral aspects of the disease will find this work a singularly effective tool to improve their study designs.

Public health has a legacy of neglect regarding social and behavioral research. Too often, prompted by technical and scientific progress, we have ignored­ even marginalized-the vital "human element" in health thinking and prac­ tice. Thus, for example, while family planning programs focused on providing a choice among safe and effective contraceptive methods (a supremely worthy goal), the central issue of sexuality and sexual behavior was generally neglected. Similarly, the enormous and important efforts to develop rapid and reliable diagnostic and treatment methods for sexually transmitted diseases helped divert attention away from the crucial issues of sexual practice. In short, we seem to have difficulty addressing the fundamental behaviors-including sex, drug taking and other intoxications, and violence-that are central to the major causes of preventable morbidity, disability, and premature mortality in the world today. Our collective reluctance to examine and understand ourselves is also expressed in the oft-repeated pipedream that scientific progress will "take care of" the HIV / AIDS pandemic by delivering a preventive vaccine, an effective cure, or both. Yet even a cursory glance at the relationship between scientific/ technical progress and health shows that meeting the scientific challenges is only one step toward effective application of the vaccine or drug. It is typical, not atypical, that hepatitis B vaccine is only now becoming relatively freely available to large populations in the developing world, more than a decade after the vaccine's licensure.

AIDS is the fourth leading cause of death among women of childbearing age and is increasing by about 8% a year in this group. * And yet, our understanding of the impact of HIV and AIDS on women's lives remains fragmented and incomplete. After a decade of struggling with mounting surveys of risk behavior, clinical trials, and behavioral interventions that were based primarily on experience with gay communities in large cities and, subsequently, on the needs of injection drug users, we have not given programs for women the attention they require if they are to be meaningful, effective, and gender appropriate. This book will introduce the reader to the range of complex issues of HIV and AIDS in women's lives. Ann O'Leary and Loretta Sweet Jemmott have assembled an impres­ sive list of authors who have contributed chapters from different disciplinary viewpoints. The reader will find information on prevention programs that have been effective for adolescent girls, on culturally specific strategies for African American and Latina women, and on the multiple issues of sub­ stance use and HIV that need to be faced by any outreach and intervention programs for drug-using women.

Although women were understudied in the early years of the epidemic, research and practice devoted to understanding and ameliorating the effects of the AIDS epidemic have begun in recent years. Women and AIDS is the first comprehensive exploration of the medical and psychosocial concerns and issues surrounding women living with HIV/AIDS. Contributors address the biomedical aspects of the disease, stress and coping factors, reproductive and childcare issues, access to care, needs of special populations such as drug-using women and adolescents, and policy recommendations. Researchers and students in psychology, public health, medicine, nursing, sociology, women's studies, and social work will appreciate this reference.

This user-friendly, comprehensive guide places evaluation in the context of HIV to give all health care professionals the necessary tools for developing and implementing successful HIV interventions. Every aspect of evaluation is discussed, including: the social and political context of evaluation coding and inter-rater reliability procedures barriers to evaluation and solution the dissemination of results the application of theory to HIV interventions. Case studies and examples from both the US and abroad to illustrate practical issues, and numerous tables and figures complement the text.

If resources for HIV prevention efforts were truly unlimited, then this book would be en­ tirely unnecessary. In a world with limitless support for HIV prevention activities, one would simply implement all effective (or potentially effective) programs without regard to expense. We would do everything useful to prevent the further spread of the virus that has already claimed hundreds of thousands of lives in the United States and millions of lives worldwide. Unfortunately, funding for HIV prevention programs is limited. Even though the amount of available funding may seem quite large (especially in the United States), it is still fixed and not sufficient to meet all needs for such programs. This was very well illustrated in the summer of 1997 when over 500 community-based organizations applied for a combined total of $18 million of HIV prevention funding from the U.S. Centers for Disease Control and Prevention (CDC). Less than one-fifth ofthese organizations received support via this funding mechanism. Hence, although $18 million may seem like a large amount of money at first blush, it is not enough to meet all of the prevention needs that could be addressed by these community-based organizations.

Planners seeking to create HIV prevention programmes in developing countries relied on published interventions successfully implemented in the industrialized world. This volume brings together HIV researchers and activists who describe intervention strategies employed primarily in developing countries. With the battle to control HIV continuing, the contributors provide insights from the field as they summarize implementation problems, successes and failures. End-of-chapter summaries and references are key features.

This volume addresses the issues surrounding combination drug therapies and the treatment of HIV/AIDS. Each chapter, written by a leading researcher, provides information on the pharmacology, clinical use - including adherence to treatment guidelines - prevention implications, mental health ramifications, and ethical and policy issues. By highlighting context as well as content, and focusing on general principles in addition to specific details, this text should be relevant and valuable for future treatment advances.

Social Networks, Drug Injectors' Lives, and HIV/AIDS recognizes HIV as a socially structured disease - its transmission usually requires intimate contact between individuals - and shows how social networks shape high-risk behaviors and the spread of HIV. The authors recount the groundbreaking use of social network methods, ethnographic direct-observation techniques, and in-depth interviews in their study of a drug-using community in Brooklyn, New York. They provide a detailed documentary of the lives of community members. They describe drug-use, the affects of poverty and homelessness, the acquisition of money and drugs, and social relationships within the group. Social Networks, Drug Injectors' Lives, and HIV/AIDS shows that social networks and contexts are of crucial importance in understanding and fighting the AIDS epidemic. These findings should revitalize prevention efforts and reshape social policy.

"I'm like a whirling leaf in the wind," said one of Dr. Lena Nilsson SchOnnesson' s patients, and another "I'm in the claws of HIV." Their voices and those of other HIV-positive patients frame the humanistic and scholarly discussion in this impor­ tant book. Dr. SchOnnesson, a Fulbright scholar at the HIV Center for Clinical and Behavioral Studies, Columbia University in 1995, has unusually extensive clinical experience in counseling HIV-positive gay men. Her work with 38 such patients treated between 1986 and 1995 is discussed in the pages that follow. Dr. SchOnnesson's longitudinal approach to clinical data is extremely unusual in the psychotherapy literature generally, and in the literature on counseling HIV­ positive men in particular. Building upon the experience of such recent scholar­ clinicians as Klitzman, Isay, Schaffner, and others, Dr. SchOnnesson adds some­ thing unique by analyzing her ongoing detailed notes of the psychotherapeutic process in a systematic quantitative as well as qualitative manner. The analysis of her data is further informed by her coauthor, Dr. Michael Ross, a therapist and investigator whose contribution to the clinical and research literature on the psychotherapeutic treatment of gay men has already been substantial.

This handbook is intended to provide a comprehensive overview of the theories, methods and approaches for reducing HIV-associated risk behaviours. The handbook addresses the subject of HIV prevention from two interrelated perspectives. First, it presents the seminal theories currently used to guide the development and implementation of HIV prevention interventions. Second, it describes prevention approaches for diverse populations at risk of HIV infection. This handbook provides a compilation of knowledge on HIV prevention by the leading authorities in the field, and should be an important resource for students, researchers and clinicians in the field.

Although women were understudied in the early years of the epidemic, research and practice devoted to understanding and ameliorating the effects of the AIDS epidemic have begun in recent years. Women and AIDS is the first comprehensive exploration of the medical and psychosocial concerns and issues surrounding women living with HIV/AIDS. Contributors address the biomedical aspects of the disease, stress and coping factors, reproductive and childcare issues, access to care, needs of special populations such as drug-using women and adolescents, and policy recommendations. Researchers and students in psychology, public health, medicine, nursing, sociology, women's studies, and social work will appreciate this reference.

Social Networks, Drug Injectors' Lives, and HIV/AIDS recognizes HIV as a socially structured disease - its transmission usually requires intimate contact between individuals - and shows how social networks shape high-risk behaviors and the spread of HIV. The authors recount the groundbreaking use of social network methods, ethnographic direct-observation techniques, and in-depth interviews in their study of a drug-using community in Brooklyn, New York. They provide a detailed documentary of the lives of community members. They describe drug-use, the affects of poverty and homelessness, the acquisition of money and drugs, and social relationships within the group. Social Networks, Drug Injectors' Lives, and HIV/AIDS shows that social networks and contexts are of crucial importance in understanding and fighting the AIDS epidemic. These findings should revitalize prevention efforts and reshape social policy.

In the nearly two decades since the HIV pandemic began, the rapid expansion of behavioral research on HIV prevention has prompted a crucial need for a sourcebook more advanced than an introductory textbook and broader and more readily accessible than a review periodical. The Handbook of HIV Prevention is intended as the first attempt to meet this need. The current state of affairs led us to edit a book that would represent the major areas of HIV behavioral research at a level appropriate for graduate students and experienced researchers in public health, medicine, nursing, education, and the social and behavioral sciences. In addition, we expect that the handbook will be useful in advanced undergraduate courses and as a reference book for health care professionals. Our plans to assemble the Handbook began in the fall of 1996 when we prepared a tentative outline of chapters and invited a large number of distinguished researchers in the field to be the authors of various chapters. We received an overwhelmingly favorable response from potential authors to our letters of invitation. After considerable effort by both the contributors and the editors the volume was completed in 1999, when all chapters went to press.

"I'm like a whirling leaf in the wind," said one of Dr. Lena Nilsson SchOnnesson' s patients, and another "I'm in the claws of HIV." Their voices and those of other HIV-positive patients frame the humanistic and scholarly discussion in this impor­ tant book. Dr. SchOnnesson, a Fulbright scholar at the HIV Center for Clinical and Behavioral Studies, Columbia University in 1995, has unusually extensive clinical experience in counseling HIV-positive gay men. Her work with 38 such patients treated between 1986 and 1995 is discussed in the pages that follow. Dr. SchOnnesson's longitudinal approach to clinical data is extremely unusual in the psychotherapy literature generally, and in the literature on counseling HIV­ positive men in particular. Building upon the experience of such recent scholar­ clinicians as Klitzman, Isay, Schaffner, and others, Dr. SchOnnesson adds some­ thing unique by analyzing her ongoing detailed notes of the psychotherapeutic process in a systematic quantitative as well as qualitative manner. The analysis of her data is further informed by her coauthor, Dr. Michael Ross, a therapist and investigator whose contribution to the clinical and research literature on the psychotherapeutic treatment of gay men has already been substantial.

Globally, action to prevent HIV spread is inadequate. Over 16,000 new infections occur every day. Yet we are not helpless in the face of disaster, as shown by the rich prevention experience analyzed in this valuable new compendium. “Best pr- tice” exists—a set of tried and tested ways of slowing the spread of HIV, of persuading and enabling people to protect themselves and others from the virus. Individually, features of best practice can be found almost everywhere. The tragedy, on a world scale, is that prevention is spotty, not comprehensive; the measures are not being applied on anywhere near the scale needed, or with the right focus or synergy. The national response may concentrate solely on sex workers, for example. Elsewhere, efforts may go into school education for the young, but ignore the risks and vulnerability of men who have sex with men. Action may be patchy geographically. AIDS prevention may not benefit from adequate commitment from all parts and sectors of society, compromising the sustainability of the response. In some countries matters are still worse—there is still hardly any action at all against AIDS and scarcely any effort to make HIV visible. It is no wonder that the epidemic is still emerging and in some places is altogether out of control.

“AIDS is kind of like life, just speeded up. ” JavonP. ,heroinaddictwithAIDS, Bronx,NewYork, 1988 “Now I’m not so much scared of dying as scared of living. ” Mike D. , heroin addict with AIDS, New Haven, Connecticut, 1998 Within little more than a decade, AIDS has been tranformed from an untreatable, rapidly fatal illness, into a manageable, chronic disease. Most of this tranformation has occurred in the past five years, accelerated by the advent of protease inhibitors and the proven benefits of combination antiretroviral therapy and prophylaxis against opportunistic infections. For people living with HIV/AIDS, these developments have offered unprecedented hope, and also new challenges. As reflected in the quotes above, some of the anxieties and anticipation of premature dying have been replaced by the uncertainties involved in living with a long-term, unpredictable illness. The role of caregivers for people with HIV/AIDS has also changed radically over this time. Earlier in the epidemic, we learned to accompany patients through illness, to bear witness, to advocate, to address issues of death, dying, and - reavement. The arrival of more effective therapy has brought with it new capabi- ties, but also new complexities, raising difficult problems concerning access to care, adherence, and toxicity.

Methodological problems have hampered researchers' efforts to understand and control AIDS since the beginning of the epidemic. This practical book addresses these problems by using actual health research case studies to develop strategies regarding design and sampling, measurement, and analysis and modeling issues. Researchers working on both biological and behavioral aspects of the disease will find this work a singularly effective tool to improve their study designs.

The reader will find information on prevention programs that have been effective for adolescent girls, on culturally specific strategies for African American and Latina women, and on the multiple issues of sub­ stance use and HIV that need to be faced by any outreach and intervention programs for drug-using women.

Public health has a legacy of neglect regarding social and behavioral research. Too often, prompted by technical and scientific progress, we have ignored­ even marginalized-the vital "human element" in health thinking and prac­ tice. Thus, for example, while family planning programs focused on providing a choice among safe and effective contraceptive methods (a supremely worthy goal), the central issue of sexuality and sexual behavior was generally neglected. Similarly, the enormous and important efforts to develop rapid and reliable diagnostic and treatment methods for sexually transmitted diseases helped divert attention away from the crucial issues of sexual practice. In short, we seem to have difficulty addressing the fundamental behaviors-including sex, drug taking and other intoxications, and violence-that are central to the major causes of preventable morbidity, disability, and premature mortality in the world today. Our collective reluctance to examine and understand ourselves is also expressed in the oft-repeated pipedream that scientific progress will "take care of" the HIV / AIDS pandemic by delivering a preventive vaccine, an effective cure, or both. Yet even a cursory glance at the relationship between scientific/ technical progress and health shows that meeting the scientific challenges is only one step toward effective application of the vaccine or drug. It is typical, not atypical, that hepatitis B vaccine is only now becoming relatively freely available to large populations in the developing world, more than a decade after the vaccine's licensure.

This user-friendly, comprehensive guide places evaluation in the context of HIV to give all health care professionals the necessary tools for developing and implementing successful HIV interventions. Every aspect of evaluation is discussed, including: the social and political context of evaluation coding and inter-rater reliability procedures barriers to evaluation and solution the dissemination of results the application of theory to HIV interventions. Case studies and examples from both the US and abroad to illustrate practical issues, and numerous tables and figures complement the text.