HIV and AIDS

HIV

HIV (Human Immunodeficiency Virus) The retrovirus that infects and attacks

the immune system, eventually causing AIDS

HIV injects its genome into lymphocytes

so that it reproduces when the cells are activated

AIDS (Acquired Immune Deficiency Syndrome)

A 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

The Course of HIV/AIDS

US Statistics

Approx. ½ million people are living with AIDS in AmericaAround 77% of adults and adolescents living with AIDS are men

http://www.avert.org/statindx.htm

Global Statistics (published in July 2008)

People living with HIV/AIDS in 2007 33.0 million Women living with HIV/AIDS in 2007 15.5 million People newly infected with HIV in 2007 2.7 million AIDS deaths in 2007 2.0

million

25 million have died since the first cases of AIDS were identified in 1981

Women and AIDSWomen account for nearly half of all people

worldwide living with HIV/AIDS Globally, girls and women are more likely than men

to contract HIV Women are often less able to protect themselves because

they are economically and culturally subordinate to men More of the virus is found in ejaculate Women progress to AIDS at a lower viral load

than men 59% of AIDS victims in sub-Saharan Africa are women. Africa has 11.6 million AIDS orphans. Their Brothers’ Keepers, 2005 documentary

Behavioral issues in HIV infection -- The ABCs

A bstinence or delaying first sex B eing safer by being faithful to one partner

or by reducing the number of sexual partners C 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

Intervention Strategies for preventing HIV/AIDS

Psychosocial Interventions Increasing 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)

Decreasing drug and alcohol use Enhancing knowledge (complacency about STIs) Increasing risk perception Increasing self-efficacy (e.g., dealing with coercion) Determining which groups to target? Community interventions? What to do…?

Psychosocial Barriers to HIV/AIDS Prevention

Despite massive educational efforts, rates of condom use and other safer sex behaviors are low.

Media depictions of sexual encounters do little to promote interventions aimed at promoting safe sex.

Misconceptions of HIV/AIDS are common. Optimistic bias and perceived invincibility are common.

Highly active HIV prevention

Holmes, U of W

Psychosocial Factors in disease progression

Stress, depression, etc.Adherence to medical regimenCoping with HIV/AIDS

Psychosocial Factors in AIDS

Studies have shown a clear relationship among psychosocial factors, disease progression, and HIV mortality (Ironson et al. chapter)

Cognitions Coping Life Stress Depression and Distress Social Support (mixed results)

Adherence to Medical Regimen

Three objectives: Support the immune system Prevent, control, or eliminate

opportunistic infections Clear the body of HIV

Medical Interventions

The HAART Regimen (highly active antiretroviral therapy) Multiple anti-HIV drugs (e.g., AZT, protease

inhibitors) are often used in an “AIDS drug cocktail”

HAART regimen is expensive ($10,000 to $15,000 per year) and difficult to follow (25 pills per day)

Must take consistently, or HIV will adapt and become resistant to drugs

80-90% of individuals who adhere have undetectable plasma HIV viral loads in 6 to 12 months

Strategies to Combat HIV Reproduction

Coping With HIV and AIDS

Psychosocial impact Stigma Impact on family Acknowledging the possibility of dying

young (and friends dying young) Depressive, suicidal thoughts common,

especially among those who feel a withdrawal of family and social support

Coping with HIV/AIDS

Problem-solving skills Relaxation training Skills for obtaining health care, SS disability, etc. Strategies for decreasing unprotected sex

(besides infecting others, this can increase the risk of secondary infections that can activate the AIDS virus)

Skills for reducing alcohol consumption (reduces immune function in PWAs)

Increase sense of control Group support

Antoni et al. (2000)

HIV-positive men received a 10-week CBSM intervention (relaxation training, cognitive restructuring, techniques to

manage anger, etc.)

How Might CBSM Work?

CBSM may lower norepinephrine levels (which tend to be elevated in HIV-infected people and inhibit the proliferation of lymphocytes)

CBMS may contribute to increased sense of mastery over the disease and lead to better diet, more exercise, and other self-care behaviors