The AIDS virus is spread by human behaviors enacted in a variety of social situations. In order to prevent further infection, we need to know more about these behaviors. This volume explores what is known about the number of people infected, risk-associated behaviors, facilitation of behavioral change, and barriers to more effective prevention efforts.
Europe's "Black Death" contributed to the rise of nation states, mercantile economies, and even the Reformation. Will the AIDS epidemic have similar dramatic effects on the social and political landscape of the twenty-first century? This readable volume looks at the impact of AIDS since its emergence and suggests its effects in the next decade, when a million or more Americans will likely die of the disease. The Social Impact of AIDS in the United States addresses some of the most sensitive and controversial issues in the public debate over AIDS. This landmark book explores how AIDS has affected fundamental policies and practices in our major institutions, examining: How America's major religious organizations have dealt with sometimes conflicting values: the imperative of care for the sick versus traditional views of homosexuality and drug use. Hotly debated public health measures, such as HIV antibody testing and screening, tracing of sexual contacts, and quarantine. The potential risk of HIV infection to and from health care workers. How AIDS activists have brought about major change in the way new drugs are brought to the marketplace. The impact of AIDS on community-based organizations, from volunteers caring for individuals to the highly political ACT-UP organization. Coping with HIV infection in prisons. Two case studies shed light on HIV and the family relationship. One reports on some efforts to gain legal recognition for nonmarital relationships, and the other examines foster care programs for newborns with the HIV virus. A case study of New York City details how selected institutions interact to give what may be a picture of AIDS in the future. This clear and comprehensive presentation will be of interest to anyone concerned about AIDS and its impact on the country: health professionals, sociologists, psychologists, advocates for at-risk populations, and interested individuals.
During the early years of the AIDS epidemic, thousands of Americans became infected with HIV through the nation's blood supply. Because little reliable information existed at the time AIDS first began showing up in hemophiliacs and in others who had received transfusions, experts disagreed about whether blood and blood products could transmit the disease. During this period of great uncertainty, decision-making regarding the blood supply became increasingly difficult and fraught with risk. This volume provides a balanced inquiry into the blood safety controversy, which involves private sexual practices, personal tragedy for the victims of HIV/AIDS, and public confidence in America's blood services system. The book focuses on critical decisions as information about the danger to the blood supply emerged. The committee draws conclusions about what was doneâ€"and recommends what should be done to produce better outcomes in the face of future threats to blood safety. The committee frames its analysis around four critical area: Product treatmentâ€"Could effective methods for inactivating HIV in blood have been introduced sooner? Donor screening and referralâ€"including a review of screening to exlude high-risk individuals. Regulations and recall of contaminated bloodâ€"analyzing decisions by federal agencies and the private sector. Risk communicationâ€"examining whether infections could have been averted by better communication of the risks.
This text provides insight into a wide range of adolescent issues. A series of contributions examines facts and fictions associated with adolescent risk, challenging some of the basic current notions underpinning approaches to the subject.
Public health has a legacy of neglect regarding social and behavioral research. Too often, prompted by technical and scientific progress, we have ignored even marginalized-the vital "human element" in health thinking and prac tice. Thus, for example, while family planning programs focused on providing a choice among safe and effective contraceptive methods (a supremely worthy goal), the central issue of sexuality and sexual behavior was generally neglected. Similarly, the enormous and important efforts to develop rapid and reliable diagnostic and treatment methods for sexually transmitted diseases helped divert attention away from the crucial issues of sexual practice. In short, we seem to have difficulty addressing the fundamental behaviors-including sex, drug taking and other intoxications, and violence-that are central to the major causes of preventable morbidity, disability, and premature mortality in the world today. Our collective reluctance to examine and understand ourselves is also expressed in the oft-repeated pipedream that scientific progress will "take care of" the HIV / AIDS pandemic by delivering a preventive vaccine, an effective cure, or both. Yet even a cursory glance at the relationship between scientific/ technical progress and health shows that meeting the scientific challenges is only one step toward effective application of the vaccine or drug. It is typical, not atypical, that hepatitis B vaccine is only now becoming relatively freely available to large populations in the developing world, more than a decade after the vaccine's licensure.
Expanding on the 1989 National Research Council volume AIDS, Sexual Behavior, and Intravenous Drug Use, this book reports on changing patterns in the distribution of cases and the results of intervention efforts under way. It focuses on two important subpopulations that are becoming more and more at risk: adolescents and women. The committee also reviews strategies to protect blood supplies and to improve the quality of surveys used in AIDS research. AIDS: The Second Decade updates trends in AIDS cases and HIV infection among the homosexual community, intravenous drug users, women, minorities, and other groups; presents an overview of a wide range of behavioral intervention strategies directed at specific groups; discusses discrimination against people with AIDS and HIV infection; and presents available data on the proportion of teenagers engaging in the behaviors that can transmit the virus and on female prostitutes and HIV infection.
This volume addresses the interface of two major national problems: the epidemic of HIV-AIDS and the widespread use of illegal injection drugs. Should communities have the option of giving drug users sterile needles or bleach for cleaning needs in order to reduce the spread of HIV? Does needle distribution worsen the drug problem, as opponents of such programs argue? Do they reduce the spread of other serious diseases, such as hepatitis? Do they result in more used needles being carelessly discarded in the community? The panel takes a critical look at the available data on needle exchange and bleach distribution programs, reaches conclusions about their efficacy, and offers concrete recommendations for public policy to reduce the spread of HIV/AIDS. The book includes current knowledge about the epidemiologies of HIV/AIDS and injection drug use; characteristics of needle exchange and bleach distribution programs and views on those programs from diverse community groups; and a discussion of laws designed to control possession of needles, their impact on needle sharing among injection drug users, and their implications for needle exchange programs.
With insightful discussion of program evaluation and the efforts of the Centers for Disease Control, this book presents a set of clear-cut recommendations to help ensure that the substantial resources devoted to the fight against AIDS will be used most effectively. This expanded edition of Evaluating AIDS Prevention Programs covers evaluation strategies and outcome measurements, including a realistic review of the factors that make evaluation of AIDS programs particularly difficult. Randomized field experiments are examined, focusing on the use of alternative treatments rather than placebo controls. The book also reviews nonexperimental techniques, including a critical examination of evaluation methods that are observational rather than experimentalâ€"a necessity when randomized experiments are infeasible.
