1. HIV and AIDS

2. HIV zHIV (Human Immunodeficiency Virus) yThe retrovirus that infects and attacks the immune system, eventually causing AIDS yHIV injects its genome into lymphocytes so that it reproduces when the cells are activated

3. AIDS (Acquired Immune Deficiency Syndrome) yA life-threatening disease caused by the human immunodeficiency virus (HIV) in which the body’s CD4 lymphocytes are destroyed, leaving the victim vulnerable to opportunistic infections

4. The Course of HIV/AIDS

5. US Statistics Approx. ½ million people are living with AIDS in America Around 77% of adults and adolescents living with AIDS are men http://www.avert.org/statindx.htm

6. Global Statistics (published in July 2008) zPeople living with HIV/AIDS in 2007 33.0 million zWomen living with HIV/AIDS in 2007 15.5 million zPeople newly infected with HIV in 2007 2.7 million zAIDS deaths in 2007 2.0 million z25 million have died since the first cases of AIDS were identified in 1981

7. Women and AIDS zWomen account for nearly half of all people worldwide living with HIV/AIDS zGlobally, girls and women are more likely than men to contract HIV yWomen are often less able to protect themselves because they are economically and culturally subordinate to men yMore of the virus is found in ejaculate yWomen progress to AIDS at a lower viral load than men y59% of AIDS victims in sub-Saharan Africa are women. yAfrica has 11.6 million AIDS orphans. yTheir Brothers’ Keepers, 2005 documentary

8. Behavioral issues in HIV infection -- The ABCs yA bstinence or delaying first sex yB eing safer by being faithful to one partner or by reducing the number of sexual partners yC orrect and consistent use of condoms for sexually active young people, couples in which one partner is HIV-positive, sex workers and their clients, and anyone engaging in sexual activity with partners who may have been at risk of HIV exposure. 3

9. Intervention Strategies for preventing HIV/AIDS zPsychosocial Interventions yIncreasing safer sex practices (e.g., attempt to counteract emotionally intense, rushed nature of many sexual encounters that are not conducive to clear thinking and negotiating about safer sex) yDecreasing drug and alcohol use yEnhancing knowledge (complacency about STIs) yIncreasing risk perception yIncreasing self-efficacy (e.g., dealing with coercion) yDetermining which groups to target? yCommunity interventions? What to do…?

10. Psychosocial Barriers to HIV/AIDS Prevention zDespite massive educational efforts, rates of condom use and other safer sex behaviors are low. zMedia depictions of sexual encounters do little to promote interventions aimed at promoting safe sex. zMisconceptions of HIV/AIDS are common. Optimistic bias and perceived invincibility are common.

11. Highly active HIV prevention Holmes, U of W

12. Psychosocial Factors in disease progression zStress, depression, etc. zAdherence to medical regimen zCoping with HIV/AIDS

13. Psychosocial Factors in AIDS zStudies have shown a clear relationship among psychosocial factors, disease progression, and HIV mortality (Ironson et al. chapter) yCognitions yCoping yLife Stress yDepression and Distress ySocial Support (mixed results)

14. Adherence to Medical Regimen zThree objectives: ySupport the immune system yPrevent, control, or eliminate opportunistic infections yClear the body of HIV

15. Medical Interventions zThe HAART Regimen (highly active antiretroviral therapy) yMultiple anti-HIV drugs (e.g., AZT, protease inhibitors) are often used in an “AIDS drug cocktail” yHAART regimen is expensive ($10,000 to $15,000 per year) and difficult to follow (25 pills per day) yMust take consistently, or HIV will adapt and become resistant to drugs y80-90% of individuals who adhere have undetectable plasma HIV viral loads in 6 to 12 months

16. Strategies to Combat HIV Reproduction

17. Coping With HIV and AIDS zPsychosocial impact yStigma yImpact on family yAcknowledging the possibility of dying young (and friends dying young) yDepressive, suicidal thoughts common, especially among those who feel a withdrawal of family and social support

18. Coping with HIV/AIDS zProblem-solving skills zRelaxation training zSkills for obtaining health care, SS disability, etc. zStrategies for decreasing unprotected sex (besides infecting others, this can increase the risk of secondary infections that can activate the AIDS virus) zSkills for reducing alcohol consumption (reduces immune function in PWAs) zIncrease sense of control zGroup support

19. Antoni et al. (2000) zHIV-positive men received a 10-week CBSM intervention (relaxation training, cognitive restructuring, techniques to manage anger, etc.)

20. How Might CBSM Work? zCBSM may lower norepinephrine levels (which tend to be elevated in HIV-infected people and inhibit the proliferation of lymphocytes) zCBMS may contribute to increased sense of mastery over the disease and lead to better diet, more exercise, and other self- care behaviors