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HIV Ed: A Global Perspective  

Ralph J. DiClemente and Nihari Patel

At the end of 2016, there were approximately 36.7 million people living with HIV worldwide with 1.6 million people being newly infected. In the same year, 1 million people died from HIV-related causes globally. The vast prevalence of HIV calls for an urgent need to develop and implement prevention programs aimed at reducing risk behaviors. Bronfenbrenner’s socio-ecological model provides an organizing framework to discuss HIV prevention interventions implemented at the individual, relational, community, and societal level. Historically, many interventions in the field of public health have targeted the individual level. Individual-level interventions promote behavior change by enhancing HIV knowledge, attitudes, and beliefs and by motivating the adoption of preventative behaviors. Relational-level interventions focus on behavior change by using peers, partners, or family members to encourage HIV-preventative practices. At the community-level, prevention interventions aim to reduce HIV vulnerability by changing HIV-risk behaviors within schools, workplaces, or neighborhoods. Lastly, societal interventions attempt to change policies and laws to enable HIV-preventative practices. While previous interventions implemented in each of these domains have proven to be effective, a multipronged approach to HIV prevention is needed such that it tackles the complex interplay between the individual and their social and physical environment. Ideally, a multipronged intervention strategy would consist of interventions at different levels that complement each other to synergistically reinforce risk reduction while simultaneously creating an environment that promotes behavior change. Multilevel interventions provide a promising avenue for researchers and program developers to consider all levels of influences on an individual’s behavior and design a comprehensive HIV risk-reduction program.

Article

Sex Workers and HIV/AIDS in India  

Sunny Sinha

The risk of HIV infection looms large among male, female, and transgender sex workers in India. Several individual, sociocultural, and structural-environmental factors enhance the risk of HIV infection among sex workers by restricting their ability to engage in safer sexual practices with clients and/or intimate partners. While most HIV prevention programs and research focus on visible groups of women sex workers operating from brothels (Pardasani, 2005) and traditional sex workers, for example, Devadasis (Orchard, 2007); there is a whole subgroup of the sex worker population that remains invisible within HIV prevention programs, such as the male, female, and transgender sex workers operating from non-brothel-based settings. This paper provides an overview of the different types and contexts of sex work prevalent in Indian society, discusses the factors that increase a sex worker’s risk of HIV infection, describes the varied approaches to HIV prevention adopted by the existing HIV prevention programs for sex workers, discusses the limitations of the HIV prevention programs, and concludes with implications for social work practice and education.

Article

HIV/AIDS: Practice Interventions  

Kosta N. Kalogerogiannis, Richard Hibbert, Lydia M. Franco, Taiwanna Messam, and Mary M. McKay

For over 20 years, social workers have been involved in service delivery for HIV and AIDS infected and affected individuals. It is estimated that more than 1 million people are living with HIV or AIDS in the United States. The rates of HIV infections continue to rise, with more than 40,000 individuals being diagnosed each year in the United States. This entry explores the current trends in HIV primary prevention, secondary prevention, and counseling and psychotherapy services for people living with or affected by HIV/AIDS.

Article

HIV in an Era of Biomedical Advances: Prevention  

Diana Rowan

Since the start of the human immunodeficiency virus (HIV) pandemic, numerous biomedical advances have caused the social-work response to shift from management of a crisis to prevention of an incurable, but treatable chronic disease. About 1.3 million people in the United States and more than 33 million people worldwide are estimated to be living with HIV. Rates of incidence in impoverished, marginalized communities are highest, with the rates continuing to increase among young African American gay and bisexual men. Other communities at high risk are people who are incarcerated, engage in sex work or other kinds of exchange sex, and participate in risky injection-drug use. Minority groups are often impacted because of reduced access to quality medical care and HIV testing. Social workers in HIV prevention work are challenged to educate clients and communities on the sexual risk continuum, provide more interventions that are culturally tailored for disadvantaged at-risk groups, and implement evidence-based HIV prevention and testing programs worldwide. The National HIV/AIDS Strategy now provides structure to funding opportunities for HIV prevention programs, and there is disparate access to effective treatments worldwide for those living with HIV.

Article

Queer Safer Sex Communication  

Kami Kosenko

Although communication scholars have been exploring the role of partner communication in sexual health promotion since the 1960s, the term safer sex, and its corollary safer sex communication, emerged in the late 1980s in the wake of the HIV/AIDS epidemic, which was and still is disproportionately affecting queer individuals. Numerous studies, along with some meta-analyses, point to the protective potential of safer sex discussions, defined here as the communicative management of health concerns with sex partners. Despite scholarly agreement regarding its importance, the term safer sex communication has received little explication, and much of what is known about it comes from studies with predominantly heterosexual samples. A review of the literature on queer safer sex communication points to some key issues related to age, race, trauma history, place, and pre-exposure prophylaxis (PrEP), and suggests important considerations for future research efforts.

Article

HIV/AIDS Politics and Policy in U.S. States and Localities  

Patricia Siplon

From the earliest days of its recognition in the United States, the condition that came to be known as acquired immunodeficiency syndrome (AIDS) has been associated with the gay community. In fact, when the U.S. Centers for Disease Control and Prevention (CDC) first made written notice of the syndrome in 1981, the acronym GRID (gay-related immune disease) was commonly, although not officially, used to describe it. In the five years that followed, the causal agent, human immunodeficiency virus (HIV), was discovered, specific demographic groups were identified as at heightened risk of infection, and transmission routes—including sexual activity, intravenous drug use, and transfusion of blood and blood products—were determined. Identification of HIV with the gay community as a major risk group had important ramifications for prevention and treatment policy, as the community mobilized a rights-based approach that advocated harm reduction over abstinence and access and affordability of treatment over the interests of the private market. These concepts carried into later debates as the world recognized the global severity of HIV and grappled for the first time ever with a goal of universal treatment access in the world’s poorest countries where the pandemic is most severe. Identification of HIV with values, conceptual structures, leadership, and mobilization drawn from the gay community also had ramifications on the social and political contexts of AIDS treatment and prevention globally, as governments and cultures that had ignored or demonized their gay populations have increased their interactions with them as “risk groups” and as political actors. Despite the remarkable inroads made into accessibility of treatment, the world remains without a vaccine, a cure, or the political will to fully implement universal treatment access, which means that eradication of the global pandemic remains elusive.

Article

HIV/AIDS and People of Color  

Michele Rountree and Courtney McElhaney Peebles

Communities of color are disproportionately burdened by the prevalence of HIV/AIDS. Research has shown that race and ethnicity in the United States are population characteristics that correlate with other fundamental determinants of health outcomes. This entry will chronicle the history of the epidemic, report the disparate impact of the disease affecting communities of color, and acknowledge the social determinants of health that contribute to the vulnerability of risk. A call to address the imbalance of health inequities, with a complement of individual-level interventions and new approaches that address the interpersonal, network, community, and societal influences of disease transmission, is discussed.