HIV is spreading rapidly, and effective treatments continue to elude science. Preventive interventions are now our best defense against the epidemic—but they require a clear understanding of the behavioral and mental health aspects of HIV infection and AIDS.
AIDS and Behavior provides an update of what investigators in the biobehavioral, psychological, and social sciences have discovered recently about those aspects of the disease and offers specific recommendations for research directions and priorities.
This volume candidly discusses the sexual and drug-use behaviors that promote transmission of HIV and reports on the latest efforts to monitor the epidemic in its social contexts. The committee reviews new findings on how and why risky behaviors occur and efforts to develop strategies for changing such behaviors. The volume presents findings on the disease's progression and on the psychosocial impacts of HIV and AIDS, with a view toward intervention and improved caregiving.
AIDS and Behavior also evaluates the status of behavioral and prevention aspects of AIDS research at the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism.
The volume presents background on the three institutes; their recent reorganization; their research budgets, programs, and priorities; and other important details. The committee offers specific recommendations for the institutes concerning the balance between biomedical and behavioral investigations, adequacy of administrative structures, and other research management issues.
Anyone interested in the continuing quest for new knowledge on preventing HIV and AIDS will want to own this book: policymakers, researchers, research administrators, public health professionals, psychologists, AIDS advocates and service providers, faculty, and students.
- AIDS and Behavior
- Copyright
- Preface
- Acknowledgments
- Contents
- Executive Summary
- PART I
- UNDERSTANDING HIV TRANSMISSION
- SEX, DRUG USE, AND HIV TRANSMISSION
- UNDERSTANDING THE DETERMINANTS OF HIV RISK BEHAVIOR
- NEUROBIOLOGICAL DETERMINANTS OF RISK BEHAVIOR
- PSYCHOSOCIAL DETERMINANTS OF RISK BEHAVIOR
- SOCIAL SCIENCE PERSPECTIVES ON BEHAVIOR AND BEHAVIOR CHANGE
- INTERVENTIONS TO CHANGE BEHAVIOR
- DISEASE PROGRESSION AND INTERVENTION
- THE RELATIONSHIP BETWEEN HIV AND THE CENTRAL NERVOUS SYSTEM
- INTERACTIONS AMONG HIV, SUBSTANCE USE, AND MENTAL ILLNESS
- THE RELATIONSHIP BETWEEN PSYCHOSOCIAL FACTORS AND HIV INFECTION
- PART II
- THE CONTEXT OF AIDS PROGRAMS AT NIAAA, NIDA, AND NIMH
- EFFECTS OF THE ADAMHA REORGANIZATION AND NIH REAUTHORIZATION
- THE BUDGET PROCESS
- THE GRANT REVIEW PROCESS
- RESEARCH FUNDING, PROGRAMS, AND PRIORITIES AT NIAAA, NIDA, AND NIMH
- NIAAA
- NIDA
- NIMH
- COLLABORATIVE PROJECTS
- THE NIH CONTEXT
- LINKAGES BETWEEN RESEARCH AND SERVICES
- AIDS PROGRAMS AT SAMHSA
- COLLABORATIONS BETWEEN RESEARCH AND SERVICES
- COORDINATION OF AIDS ACTIVITIES WITHIN THE PUBLIC HEALTH SERVICE AND THE DEPARTMENT OF HEALTH AND HUMAN SERVICES
- 1 Introduction
- PART I Research Findings and Opportunities
- 2 Understanding HIV Transmission
- SEXUAL TRANSMISSION
- HIV RISK AND INJECTION DRUG USE
- CRACK COCAINE AND HIV RISK: THE INTERSECTION OF DRUG USE AND SEXUAL BEHAVIOR
- ALCOHOL USE AND SEXUAL TRANSMISSION
- MONITORING THE EPIDEMIC
- PREVALENCE AND INCIDENCE OF HIV INFECTION
- FACTORS INFLUENCING THE EPIDEMIC'S COURSE: RISKY ACTS, SOCIAL NETWORKS, AND UNSAFE PLACES
- CONCLUSION AND RECOMMENDATIONS
- CONCLUSION
- RECOMMENDATIONS FOR UNDERSTANDING HIV TRANSMISSION
- 3 Understanding the Determinants of HIV Risk Behavior
- NEUROBIOLOGICAL DETERMINANTS OF RISK BEHAVIOR
- NEUROBIOLOGICAL BASIS OF DRUG-USING BEHAVIOR
- PSYCHOSOCIAL DETERMINANTS OF RISK BEHAVIOR
- PSYCHOSOCIAL PERSPECTIVES ON RISK BEHAVIOR
- PSYCHOLOGICAL THEORIES OF BEHAVIOR CHANGE
- SOCIAL SCIENCE PERSPECTIVES ON BEHAVIOR AND BEHAVIOR CHANGE
- Social Networks
- Social Norms
- Community
- Cultural Sensitivity
- Women and Gender Dynamics
- INTERVENTIONS TO CHANGE BEHAVIOR
- INDIVIDUAL-FOCUSED INTERVENTIONS
- Sexual Behavior
- Injection Drug Use
- COMMUNITY-FOCUSED INTERVENTIONS
- Sexual Behavior
- Injection Drug Use
- MAINTAINING BEHAVIOR CHANGE AND PREVENTING RELAPSE
- EVALUATING THE EFFECTS OF AIDS INTERVENTIONS
- CONCLUSION AND RECOMMENDATIONS
- CONCLUSION
- RECOMMENDATIONS FOR UNDERSTANDING THE DETERMINANTS OF HIV RISK BEHAVIOR
- 4 Disease Progression and Intervention
- THE RELATIONSHIP BETWEEN HIV AND THE CENTRAL NERVOUS SYSTEM
- EFFECTS OF HIV ON THE CENTRAL NERVOUS SYSTEM: DEFINING THE ISSUES
- STAGING AND CELLULAR SITES OF CENTRAL NERVOUS SYSTEM INFECTION IN AIDS DEMENTIA COMPLEX
- MECHANISMS FOR CAUSING SYMPTOMS
- MECHANISMS OF CENTRAL NERVOUS SYSTEM INJURY
- SIGNIFICANCE OF AIDS DEMENTIA COMPLEX FOR OTHER CENTRAL NERVOUS SYSTEM DISORDERS
- CLINICAL SIGNIFICANCE OF AIDS DEMENTIA COMPLEX
- INTERACTIONS AMONG HIV, SUBSTANCE USE, AND MENTAL ILLNESS
- ALCOHOL AND THE IMMUNE SYSTEM
- DRUG USE AND HIV/AIDS
- Natural History of HIV Infection Among Drug Users
- Medical Care for HIV-Infected Drug Users
- INTERVENTIONS FOR THE SERIOUSLY MENTALLY ILL
- THE RELATIONSHIP BETWEEN PSYCHOSOCIAL FACTORS AND HIV INFECTION
- PSYCHONEUROIMMUNOLOGY
- COPING WITH HIV/AIDS
- CAREGIVING FOR PEOPLE WITH HIV/AIDS
- Informal Caregivers
- Formal Caregivers: Health Care Professionals
- Future Research on Caregiving
- CONCLUSION AND RECOMMENDATIONS
- CONCLUSION
- RECOMMENDATIONS FOR DISEASE PROGRESSION AND INTERVENTION
- PART II Managing the AIDS Research Programs at NIAAA, NIDA, and NIMH
- 5 The Context of AIDS Programs at NIAAA, NIDA, and NIMH
- THE REORGANIZATION OF ADAMHA
- BACKGROUND
- STRUCTURAL EFFECTS OF THE ADAMHA REORGANIZATION
- AIDS RESEARCH AND THE NIH REAUTHORIZATION
- THE BUDGET PROCESS
- ADAMHA BUDGET PROCESS, FY 1983 TO FY 1992
- WORKING WITHIN THE NIH PROCESS
- THE GRANT REVIEW PROCESS
- CONCLUSION AND RECOMMENDATIONS
- CONCLUSION
- RECOMMENDATIONS RELATED TO THE CONTEXT OF AIDS RESEARCH
- 6 Research Funding, Programs, and Priorities at NIAAA, NIDA, and NIMH
- FUNDING AIDS ACTIVITIES
- CATEGORIZING AIDS RESEARCH
- MECHANISMS OF SUPPORT
- NIAAA
- PROGRAMS AND PRIORITIES
- BIOMEDICAL/BIOBEHAVIORAL RESEARCH
- Epidemiological Research
- Psychosocial Research
- Social-Structural Research
- GRANTS
- NIDA
- PROGRAMS AND PRIORITIES
- Biomedical/Biobehavioral Research
- Epidemiological Research
- Psychosocial Research
- Social-Structural Research
- Drug Abuse Treatment Research
- GRANTS
- NIMH
- PROGRAMS AND PRIORITIES
- Biomedical/Biobehavioral Research
- Epidemiological Research
- Psychosocial Research
- Social-Structural Research
- GRANTS
- COLLABORATIVE PROJECTS
- AIDS RESEARCH CENTERS
- TRAINING
- THE NIH CONTEXT
- CONCLUSION AND RECOMMENDATIONS
- CONCLUSION
- RECOMMENDATIONS FOR RESEARCH FUNDING, PROGRAMS, AND PRIORITIES AT NIAAA, NIDA, AND NIMH
- 7 Linkages Between Research and Services
- AIDS PROGRAMS AT SAMHSA
- COLLABORATIONS BETWEEN RESEARCH AND SERVICES
- NIAAA
- NIDA
- National AIDS Demonstration Research Program (NADR)
- NIDA/SAMHSA HIV Prevention/Intervention Training Courses
- Outreach and Bleach Distribution
- Other Collaborations
- NIMH
- AIDS Research Centers
- AIDS Health Care Worker Training Program
- NIMH (with CDC, HRSA, NIDA, NIAAA, and NICHD) Multisite Trial of Behavioral Strategies to Prevent the Further Spread of HIV…
- HIV/AIDS Mental Health Services Demonstration Program
- Other Collaborations
- BARRIERS TO COLLABORATION
- COORDINATION OF AIDS ACTIVITIES WITHIN THE PUBLIC HEALTH SERVICE AND THE DEPARTMENT OF HEALTH AND HUMAN SERVICES
- CONCLUSION AND RECOMMENDATIONS
- CONCLUSION
- RECOMMENDATIONS FOR LINKAGES BETWEEN RESEARCH AND SERVICES
- Bibliography and References
- APPENDIXES
- A Grants Analysis Methodology
- SOURCES OF INFORMATION
- DATABASE
- LIMITATIONS
- B Abbreviations and Acronyms
- C Acknowledgments
- D Contributors
- Index
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