Tag Archives: hiv prevention

What Does Our Past Tell Us About Our Future? The Essential Role of Psychologists in Fighting HIV

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(L-R) Dr. Rich Wolitski (HHS/OHAIDP); Dr. Fayth Parks (Georgia Southern University) APA Ad Hoc Committee on Psychology & AIDS (COPA) chair and symposium co-chair; Dr. Sherry Wang (Santa Clara University) COPA symposium co-chair; Ms. Cherie Mitchell (APA); Dr. Karen Ingersoll (University of Virginia); Dr. Richard Jenkins (NIH/NIDA); and Dr. Ramani Durvasula (California State University, Los Angeles)

This article is cross-posted from the HIV.gov blog with their permission.

 

By Richard Wolitski, PhD (Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services)

 

Since the early days of the HIV/AIDS epidemic, psychologists have been essential in the response to HIV:

  • They offered mental health support for people living with, or at risk for, HIV—as well as for their families and communities, and those who provide HIV medical care and social services.
  • Psychologists developed programs to educate people about HIV and motivate behavior change to reduce risk.
  • They counseled and supported those who were diagnosed, and also played important roles in working to eliminate the stigma that attaches to HIV/AIDS, sexual minority status, gender identity, substance use, and other characteristics associated with HIV infection.
  • They conducted research that gave us an understanding of cognitive, behavioral, and social determinants of health that create health disparities.

 

They continue to do all of these things, and they play a vital role as the response to HIV/AIDS continues to evolve.

This year, the professional organization for psychologists, the American Psychological Association (APA), celebrated its 125th anniversary. The APA has been deeply involved in the response to HIV/AIDS in the United States:

  • From 1996-2014, the Centers for Disease Control and Prevention (CDC) funded APA’s Behavioral and Social Science Volunteer (BSSV) Program. The program established a national network of more than 300 psychologists, sociologists, anthropologists, and public health experts who provided capacity-building technical assistance to improve the delivery and effectiveness of HIV prevention services to more than 700 organizations.
  • And from 1991-2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) funded APA’s HIV Office for Psychology Education (HOPE) Program, which trained more than 36,500 psychologists and allied mental health providers about HIV, substance use, and mental health.

 

Today, the organization continues its mission to address the ongoing toll of HIV on the mental and physical health of people living with HIV. You can view information about activities, events, and resources on the APA’s HIV webpage.

 

Dr. Arthur C. Evans, Jr. , PhD, APA’s Chief Executive Officer, expressed his support for APA’s role in this work. He shared with me that he sees psychology’s role in this way:  

Psychology plays a critical role in HIV prevention and treatment by promoting behaviors aimed at helping to improve overall health, mental health and well-being and providing a better understanding of social and cultural factors, such as stigma and culturally appropriate counseling and treatment interventions. We know that access to quality behavioral health services facilitate better outcomes across the HIV care continuum, including viral suppression.

Dr. Arthur C. Evans, Jr., PhD

 

Given the organization’s commitment and long track record of service to the HIV community, I was honored when APA asked me to be a discussant as part of the 125th Anniversary Talk, Past, Present and Future of HIV/AIDS Science and Practice in Psychology. Under the skillful direction of co-chairs Dr. Fayth Parks and Dr. Sherry Wang, the panelists addressed a number of important topics:

  • Eugene Farber, PhD, ABPP, Emory University School of Medicine, The Future of Psychology as a Health Service Discipline: Clinical Lessons from the HIV Epidemic
  • Ramani Durvasula, PhD, California State University, Los Angeles: A History of HIV/AIDS in Women: Shifting Narrative and a Structural Call to Arms
  • Karen Ingersoll, PhD, Professor of Psychiatry and Neurobehavioral Sciences at the Center for Behavioral Health & Technology, University of Virginia: Internet Intervention for HIV+ Substance Users to Improve ART Adherence and Addictive Behaviors
  • Richard Jenkins, PhD, Health Scientist Administrator, Prevention Research Branch, National Institute on Drug Abuse: Roles for Psychologists in a World of Changing Epidemics and Policies

Each of the presentations drew attention to the ways that psychologists have contributed to the fight against HIV. A key point made by all the participants is that behavioral approaches to HIV prevention, care, and treatment optimize biomedical approaches—and that the two are inextricably linked.

Dr. Eugene Barber speaking
Dr. Eugene Farber, Emory University

Dr. Gene Farber set the frame for the session by reflecting on the essential role of behavioral health service providers in supporting a humanistic, culturally responsive, and patient-centered care experience for people living with HIV. He stressed that behavioral health services must encompass not only assessment and treatment of behavioral disorders but also interventions to prevent the onset of other health conditions and to optimize biopsychosocial well-being. He also noted that psychologists can make substantial contributions to patient care and evaluation in medical settings.

Dr. Karen Ingersoll took his points a step further to show how psychologists can help individuals even when in-person contact is impossible. She is working on finding better ways to support substance users who are living with HIV—particularly those in rural areas, where HIV and other types of care are not always available and may require time away from work. These individuals are at significantly higher risk for nonadherence to their HIV medications and disengaging from care—so Dr. Ingersoll and her colleagues have developed an interactive online video intervention  that features peer role models offering advice and support to viewers. (Much like our own Positive Spin series, which takes a similar approach to supporting people living with HIV to achieve viral suppression.) This behavioral intervention is currently being tested to see if it can support substance users to take full advantage of biomedical treatment for their HIV disease.

Dr. Ramani Durvasula spoke about the need for holistic approaches to psychological care for women living with HIV. Her presentation focused on “the story of HIV in women,” which includes the multiple challenges women have faced in attempting to:

  • Get information on HIV risk;
  • Obtain an HIV diagnosis, care and treatment; and
  • Participate in HIV clinical trials.

For many women, neither biomedical or behavioral interventions were available.

Dr. Durvasula then discussed the current need for psychologists to be aware of the multiple psychosocial stressors women with HIV face (e.g., economic and caregiving burdens, relational issues, stigma, intersectional discrimination) and how they affect women’s physical health. She also emphasized the need to focus on women’s resiliencies, strengths, and growth rather than just their HIV disease. She ended with the observation that, for the future, psychology training programs should be looking at social justice and advocacy training as key to producing psychologists with the skill sets necessary for the future.

Finally, Dr. Richard Jenkins took the audience through a history of the role of psychologists in the U.S. epidemic, including a look at the ways in which the advent of antiretroviral therapy (ART) and other biomedical approaches have pushed many behavioral interventions to the margins. However, he noted that many of issues that affected people living with HIV in the early days of the epidemic persist and have not been eliminated by effective biomedical treatment, including stigma, access to care, and racial/ethnic disparities. He ended his presentation with a series of questions about how to connect psychologists to opportunities in HIV work, and raise the value of psychology for workforce development related to HIV.

As I listened to these passionate, committed professionals, I thought about the long history of the HIV/AIDS epidemic in the United States. I thought about how our early efforts, which were based on the best information we had at the time, created systems and approaches that have sometimes hampered our efforts to respond to the realities of today’s epidemic.

For example, when the first HIV test became available, we created a standalone system for HIV testing that was supported with siloed funding (meaning the funds could only be used for HIV testing—not any follow-up care or treatment). This was necessary because of the large number of people who needed to be tested and the fact that many people were unwilling to be tested by their usual healthcare providers. They didn’t want their providers to know they were at risk for infection or did not want information about their risk and their HIV test results to be recorded.

So, we set up stand-alone systems for anonymous testing—meaning your name was never attached to your HIV test. You were given a number that matched the one on the vial of blood the worker at the testing site took from you, and you had to have that number to get your results. This approach was intended to alleviate the stigma of testing—but it also meant that we were not able to set up linkages to care and treatment for newly diagnosed people.

The lack of connection with health care was further reinforced—first, by the absence of effective treatment, and, then, for almost three decades, by guidelines indicating that ART was not needed until later in the course of the infection, when damage to the immune system became clear. This history—and the fact that funding streams were established for HIV testing separately from health care—have required substantial changes to facilitate immediate linkage to care, and establishing late in the epidemic coordinated prevention, care, and treatment plans.

Another way that our past response affects our future is in the way that surveillance systems were established. Initially we were focused on AIDS. We did not know what caused it, and we focused on documenting the cases when and where they were identified and when and where the person died. We did not need to gather data to support engagement in HIV care over a lifetime. We were focused on keeping people alive for the next year (or month) and preventing new cases. This changed as we learned what caused HIV, its effects on the body and how to treat it effectively. As changes occurred, we had to start playing catch-up on the surveillance front, and we continue to wrestle with how to collect data in ways that will help us end the epidemic.

We know now that being diagnosed and beginning HIV treatment as soon as possible are essential to the health of people living with HIV. We also know that good physical health and good mental health are closely connected, and that people who feel a sense of well-being are also more likely to feel motivated to care for their bodies. That’s particularly important for people living with HIV.

Our goal is to support every person to engage in care, remain on treatment, and achieve viral suppression—and that goal can only be reached if people feel empowered to take charge of their healthcare. That is where the contributions of my colleagues at APA come in.

Even though biomedical tools are clearly the way we will ultimately win this battle against the HIV epidemic, they will not work if people do not engage in the behaviors that are needed to use them effectively. Psychologists have the training and the skills to help them do just that.


Filed under: AIDS, Health Disparities, Human Rights and Social Justice Tagged: aids, AIDS research, behavioral health, discrimination, HIV, hiv prevention, HIV treatment, mental health, stigma

Latinxs: Take Action to Stop HIV

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By Karen Nieves-Lugo, PhD, MPH (Postdoctoral Fellow at George Washington University)

October 15th is National Latinx AIDS Awareness Day, and this year’s theme is “We’ll Defeat AIDS con Ganas!” But why is it important to talk about acquired immunodeficiency syndrome (AIDS) in the Latino community? Latinxs are disproportionally affected by the human immunodeficiency virus (HIV)—the virus that causes AIDS. Our community represents 17% of the total U.S. population, but accounts for 21% of all new HIV infections and 21% of people living with HIV.1 In addition, research shows that Latinxs are more likely to receive late diagnosis and HIV care compared to other races and ethnicities.2

Benita Ramírez3, a Honduran activist and poet living with HIV, wrote:

I dance

the sound of the wind

lifts my hair

of my old spirit

I learned to succeed.

Drawing inspiration from the title of Benita’s poem “Triumph,” the pathway to prevent new HIV infections is early detection and treatment of the disease in order to avert heath complications. By detecting HIV early and connecting to care, people living with HIV can have better quality of life and decrease the risk of transmission of HIV by adhering to treatment. While testing and treatment are steps an individual must decide to take on their own, we as a community should provide support wherever possible. Together we can make a difference.

What kind of action can we do?

Let’s start talking about HIV with our family, partner(s), friends, peers, and neighbors. Educating ourselves about HIV–how it is transmitted, how to practice safer sex, and how to use condoms–not only prevents new infections, but also empowers Latinxs to protect themselves. It’s also important to talk about HIV prevention with our youth because they are one of the most vulnerable groups in our community. Let’s talk to our teens about the ways to have safer sex to decrease their risk of getting HIV and other sexually transmitted infections.

Fight stigma and discrimination. Negative attitudes about HIV can discourage Latinxs from seeking testing and treatment services. Some people avoid getting tested for HIV out of fear of being rejected or discriminated against. As a Latina, I know that a central value in our community is to take care of our loved ones and that should not exclude those living with HIV. Supporting your loved ones to seek testing, prevention, and treatment services is a way of honoring them and our community. If you are a leader in your neighborhood, start a dialogue about HIV and encourage your community to get tested. The support from our family, friends, peers, and community can ease the potential physical and emotional difficulties of living with HIV. By destigmatizing HIV and encouraging community members to get tested, we can make a difference in early detection and treatment. These are the most effective strategies to stop HIV in our community.

Ask to be tested for HIV. Raising our voices to get tested for HIV is an important prevention measure, even when we do not recognize having any risk factor (e.g. multiple partners, drug use, having unprotected sex). Research shows that over a third of Latinxs (36%) were tested for HIV late compared to 31% of Black and 32% of White populations4. Although receiving an HIV diagnosis is frightening, an early detection brings the opportunity to take care of ourselves preventing health complications and transmitting HIV to others.

You can talk to your healthcare provider about getting tested or visit community organizations that offer free and anonymous HIV testing.  Many of these organizations have staffs who speak English and Spanish, understand our culture, and offer information about HIV prevention and access to care regardless of your immigration status.

Take action if you are HIV positive. When living with HIV, it is important to remain in regular care. As any other chronic disease (e.g. diabetes, hypertension) having regular treatment improves the quality of life, allowing people to live longer, healthier lives. Using medication as directed by your healthcare provider is beneficial for your health and reduces the risk of HIV transmission to others.

Together we can make a difference. In 2010, President Obama signed a National HIV/AIDS Strategy that outlines the principles, priorities, and actions needed to win the battle against HIV. The goals of this plan are: reducing HIV, incidence, increasing access to care and optimizing health outcomes and reducing HIV-related health disparities5. Some of the strategies to achieve these goals are: increase HIV testing, adhere to HIV treatment and remain in care. We need to take advantage of that strategy and advocate for our community in order to fight against HIV. History has shown that when we are united as a community we can be successful, overcome obstacles, and gain respect through our work and social actions. I am confident that in this occasion we can also win the battle against HIV, stopping new HIV infections and improving the health of those Latinxs living with HIV. We have the power to change our history and make a difference in our community.

We want to hear from you – Tell us in the comments:

  • What we can do as a community to fight against HIV?
  • What do you do to encourage other Latinxs seeking testing and treatment services for HIV?
  • What tools and strategies do you have to manage being HIV positive?

Acknowledgements: Thank you to Veronica Pinho and Maria Cecilia Zea for their encouragement in the development of this blog.

Biography:

Karen Nieves-Lugo, PHD, MPH, was born and raised in Mayaguez, Puerto Rico. She obtained her doctoral degree in Psychology at the University of Puerto Rico, Rio Piedras Campus and has a master’s degree in Public Health from the University of Puerto Rico, Medical Sciences Campus. She is a postdoctoral fellow at George Washington University, Department of Psychology. Dr. Nieves-Lugo’s research focuses on health disparities, aging, sexuality, and chronic diseases specifically examining the role of cultural, psychological and behavioral factors significant to HIV/AIDS. She has worked with Latino populations in research focused on: the experiences of sexual migration among Dominican gay men; the prevalence of eating disorders and body image among Puerto Rican college men; the relationship of gender roles and sexuality in the prevention of HIV infection among Puerto Rican heterosexual men; and the psychological and behavioral factors related to adherence to HIV medication among Puerto Rican men. She is a principal investigator in a Ruth L. Kirschstein National Research Service postdoctoral fellowship (F32) award funded by the National Institute of Mental Health, where she is examining the relationship of depression and substance use (alcohol, tobacco and drug use) with physical function over time in HIV-infected veterans compared to uninfected veterans in VACS. Dr. Nieves-Lugo is a member of the District of Columbia Center for AIDS Research (CFAR), the MSM and Sexual Minorities CFAR Scientific Interest Group, the Mid-Atlantic CFAR Consortium of Latinos and HIV, the Physical Function Working Group, Veterans Aging Cohort Study, and the American Psychological Association divisions 20 and 44.

 

References:

1 Center of Disease Control and Prevention. (2016). Today’s HIV/AIDS epidemic. Retrieved from http://www.cdc.gov/nchhstp/newsroom/docs/factsheets/TodaysEpidemic-508.pdf.

2 Dennis, A. M., Napravnik, S., Seña, A. C., & Eron, J. J. (2011). Late entry to HIV care among Latinos compared with non-Latinos in a southeastern US cohort. Clinical Infectious Diseases, 53(5), 480-487.

3 Evers, L. (2010) “I´m black, I´m a woman and I am HIV positive. But I am going to make a difference”. Retrieved from https://www.trocaire.org/blogs/make-a-difference.

4 “Latinos and HIV/AIDS”. (2014, April 15). Retrieved from http://kff.org/hivaids/fact-sheet/latinos-and-hivaids/

5 “HIV/AIDS National Strategies”. (2010, July). Retrieved from https://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf


Filed under: AIDS, Culture, Ethnicity and Race, Health Disparities Tagged: aids, health disparities, HIV, hiv prevention, HIV testing, HIV treatment, HIV/AIDS research, Latina, Latino, Latinx, National Latino HIV/AIDS Awareness Day

Why HIV Providers Should Care About the Orlando Shooting

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By David J. Martin, PhD, ABPP (Senior Director, APA Office on AIDS)

In the aftermath of the mass shooting of LGBT people in an Orlando nightclub on June 12, 2016, there was a great deal of discussion concerning the shooter’s motives. Was it a hate crime? An act of terrorism? Members and allies of the LGBT community have come together to express their support for the victims and to denounce violence against LGBT people.

Although the solid links between the LGBT community and the HIV prevention and treatment communities resulted in a strong show of solidarity, there is another reason HIV care providers and educators should be concerned about the shooting and its aftermath: It is an instance of the stigma that can increase the risk of HIV transmission and reduce the ability of people with HIV to fight their disease.

Although most LGBT community members demonstrate resilience in the face of these psychosocial factors, they do take a toll. These factors have been associated with poor mental health (increased depression, anxiety, loneliness, suicide ideation/attempt), diminished self-esteem, and drug and alcohol use/misuse.  

Just as important, they can increase the risk of HIV transmission in the LGBT community. And for those living with HIV, they may diminish the body’s ability to fight HIV beyond the damage done by the virus itself:

  • In an early study, Steve Cole and his colleagues reported that gay men with HIV who concealed their sexual orientation demonstrated faster disease progression than gay men with HIV who did not conceal their sexuality.
  • In a later study, Dr. Cole and his colleagues reported that gay men with high levels of autonomic nervous system activity (ANS: a measure of stress) experienced impaired response to anti-HIV medication—their viral loads prior to starting anti-HIV medication did not drop nearly as much as those with low ANS levels.
  • In 2003, Ron Stall and his colleagues reported on the impact of psychosocial health problems (polydrug use, depression, childhood sexual abuse) on high-risk sexual behavior among gay men; they found that the more of these health problems gay men had, the higher their sexual risk. Similarly, in 2007, Brian Mustanski and his colleagues demonstrated the role of psychosocial health problems (binge drinking, street drug use, regular marijuana use, psychological distress, sexual assault, partner violence) in increasing high-risk sex, and in 2012, Ann O’Leary and her colleagues also reported similar findings. They suggested that the overall constellation of findings suggests that “cumulative adverse psychosocial health conditions of any sort seem to exert their negative effects on HIV risk and infection.” Dr. O’Leary and her colleagues also found that optimism and education lessened (but did not eliminate) these effects.

The Orlando mass shooting is another manifestation of the multiple psychosocial insults that still confront the LGBT community. The recent findings cited here (and others) suggest that, in addition to their impact on the mental health of the LGBT community, these insults contribute to increased risk for HIV and diminished physical health among people with HIV.  For these reasons, HIV providers need to continue partnering with their LGBT allies in confronting anti-LGBT bias and discrimination.

You can visit the American Psychological Association’s Office on AIDS website for information on psychology and HIV.  While there, you can also read the Resolution Opposing HIV Criminalization recently passed by the APA Council of Representatives. The Psychology and AIDS Exchange is a topical newsletter on emerging HIV-related issues.

Image source: Flickr user Ashley Van Haeften via Creative Commons


Filed under: AIDS, LGBT Issues Tagged: aids, discrimination, HIV, hiv prevention, HIV risk, HIV/AIDS research, homophobia, LGBT, Orlando shootings, prejudice, stigma