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Hiv/Aids Prevention

General Epidemiology of HIV

Increasing numbers of people are living with the human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). Worldwide, between 35.9 million and 44.3 million people are living with the virus, and in 2004 alone, between 4.3 million and 6.4 million people became infected with HIV. In the United States, an estimated 349,000 adults and adolescents were living with HIV/AIDS at the end of 2003.

Not all ethnic and racial groups in the United States have been affected by the HIV/AIDS epidemic equally. African Americans and Latino/as have been disproportionately affected by HIV/AIDS in comparison with their proportional distribution in the general U.S. population. This disparity is especially pronounced for women. In 2003, African American and Latina women together represented about 25% of the female population, yet they accounted for 83% of reported AIDS diagnoses. Although it is not possible to fully explain these ethnic and racial disparities in HIV/AIDS rates, most experts believe they are related to social and economic phenomena (e.g., poverty, inadequate access to preventive health services, discrimination, and increased rates of social violence and incarceration).

HIV Prevention: What Works

A number of HIV prevention efforts in the United States have generally been able to slow rates of infection, and the effectiveness of several different HIV prevention programs has been proved scientifically. Research on HIV prevention programs has shown that in order for programs to be most effective, they must be targeted to a specific population and address the specific cultural, social, linguistic, and developmental needs of that population. Thus, a one-size-fits-all approach cannot be used for HIV prevention with different ethnic and racial groups, and programs that have been developed for one ethnic or racial group need to be culturally modified and tailored before use with another group.

In addition to being culturally specific, the most effective HIV prevention efforts reach people in a variety of settings with a range of health-promoting messages. They are intensive and long term, address the sometimes hidden social barriers to effective prevention, and provide populations at risk with the information, support, and skills needed to change high-risk behavior. Effective HIV prevention strategies teach people the skills they need to negotiate difficult social situations, continually reinforce behavioral-change techniques to enhance long-term behavior change, and promote safer practices by ensuring access to condoms and sterile needles. Once people decide to reduce or eliminate their risk, they also need familial and community support for sustained healthy decision making.

HIV Prevention: Multiple Levels of Intervention

Although the ultimate goal of any HIV prevention program is to significantly decrease the likelihood that people will become infected with HIV, approaches used to bring about this outcome may vary. There are generally four levels at which interventions may work to lower rates of HIV infection: (1) individual (changes in personal risk behaviors), (2) romantic couple and family (changes in risk behaviors based on the relationships people share), (3) community (changes in group risk behaviors within a specified community), and (4) policy and legal level (changes in structural factors, such as those related to poverty and discrimination). The majority of scientifically tested interventions for ethnic and racial minority populations have focused on the individual level. Several literature reviews and meta-analyses of wellcontrolled behavioral interventions aimed at decreasing the spread of HIV among diverse samples of ethnic and racial minority adolescents and adults have shown that such programs can reduce HIV-risk-associated behavior and theory-based determinants of such behavior. Despite the benefits of the programs that have been investigated in these reviews, several limitations have been noted (e.g., lack of sustained behavioral change).

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