Newswise — EDITORS: Twenty-five years ago this week, what became known as the first reported cases of Acquired Immune Deficiency Syndrome, AIDS, appeared in the federal government's Morbidity and Mortality Weekly Report. Indiana University sexual health experts William L. Yarber, senior director of the Rural Center for AIDS/STD Prevention; Catherine Sherwood-Puzzello, clinical assistant professor in the Department of Applied Health Science; and Michael Reece, director of the Sexual Health Research Working Group, reflect on the devastating epidemic and the challenges ahead.
SOCIAL AND CULTURAL OBSTACLES STEM MEDICAL SUCCESSES
William L. Yarber, a professor of applied health science at Indiana University and senior director of the Rural Center for AIDS/STD Prevention, wrote the country's first school AIDS prevention curriculum in 1987 at the request of the federal government. He has conducted research involving STD prevention for more than 30 years and has been a health educator since his days as a high school health teacher in the late 1960s. He said the AIDS epidemic has highlighted the best and worst of American culture.
"Hopefully we can look back with some pride, and yet feel some real remorse, and maybe some shame, about how the world and cultures responded to this," Yarber said. "It's impacted marginalized persons, persons in poverty, disenfranchised individuals. For some individuals in our country, those are discardable persons."
The best: Yarber said the public health and medical community has rallied to address the AIDS/HIV epidemic. He said many people and groups in our country have shown support and empathy for people affected by AIDS or HIV. This is evident through volunteers who provide support for people with AIDS and through people and groups who choose to look at people who have HIV in a way that is not discriminatory or judgmental, recognizing they have emotional and physical needs.
The worst: The AIDS/HIV epidemic has made homophobia more obvious, Yarber said. It has shown Americans' discomfort with injection drug users and prostitution through an unwillingness to support prevention strategies such as needle exchange programs, which are used in other countries, and to provide prevention information to prostitutes. Debates about sexuality education, such as whether condoms should be provided or abstinence emphasized, often run contrary to scientific findings and reveal an ambivalence about human sexuality and sexuality education, Yarber said.
"From a public health aspect, many of the issues involving sexuality and morality reveal some righteousness," Yarber said. "It reveals some ambivalence about human sexuality and sexuality education in our country. These have impeded the progress."
Many of these issues are more severe in the rural areas. Yarber said AIDS and HIV cannot be addressed medically alone. A successful approach needs to involve prevention, social support and a cultural understanding that this is a medical problem, not a moral issue.
For more information about RCAP, visit http://www.indiana.edu/~aids/. The Department of Applied Health Science is in the School of Health, Physical Education and Recreation at IU Bloomington.
NEW GENERATION OF HIV STUDENTS HAS MORE KNOWLEDGE, LESS FEAR
HIV, AIDS and condoms are familiar concepts for youth today, but there still are challenges in educating students about their risk, said Catherine Sherwood-Puzzello, a clinical assistant professor in Indiana University Bloomington's Department of Applied Health Science. Her research and teaching interests include human sexuality and public health education.
"The current generation has always known about HIV. It is a disease that has been part of their vocabulary. Just the other day, a student in one of my courses said, 'I wonder what it was like when condoms weren't talked about and you had to ask a pharmacist to get a box for you. That must have been really odd.' It made me think about how we have evolved. We are able to talk more openly about sexual health issues and have the prevention methods accessible."
Despite a greater awareness of the disease and its transmission, many young people don't believe they could acquire HIV.
"What I have experienced in the last 25 years is less fear about HIV, particularly the fact that it isn't transmitted like a cold. Some students have a hard time understanding the issues regarding the severity and fatal outcome of HIV infection. Some have the belief that 'it can't happen to me,' and even if they do become infected, there are currently medications that are allowing HIV-positive individuals to live longer and have a better quality of life," Sherwood-Puzzello said.
The Centers for Disease Control and Prevention estimates that 20,000 new infections occur each year among youth.
"Just because HIV/AIDS is not in the headlines like it was 20 to 25 years ago doesn't mean it's not an important public health concern," she said. "We have learned that the best education on HIV/AIDS is to be age-appropriate, be honest, give facts and share with students what this disease has done to individuals, families and communities on a global level."
MORE FOCUS NEEDED ON MENTAL HEALTH'S ROLE IN HIV PREVENTION AND CARE
Michael Reece, assistant professor in the Department of Applied Health Science at IU Bloomington and director of the Sexual Health Research Working Group, said the 25th anniversary of AIDS is a reminder to the world that we still have much work to do in terms of preventing HIV and caring for those already living with the virus.
"While there have been dramatic improvements in the treatments available for the physiological consequences of infection with HIV, there remains the need for a continued focus on the psychological and social impact of HIV infection," Reece said. "There is a critical need, in particular, to make mental health care more available and responsive to the diverse communities around the globe who continue to be diagnosed with HIV at alarming rates."
Reece and his research team have been studying the psychological consequences of HIV infection and the community-based systems designed to be responsive to individuals facing psychological challenges. They currently are wrapping up a five-year study to investigate the effectiveness of strategies designed to increase the extent to which ethnic minority individuals seek HIV-related mental health care following an HIV diagnosis.
"For decades there has been an assumption by many in the social services system that African American and Latino individuals were not likely to seek mental health care, but that assumption has been wrong; it is the system of providing care that has needed to change in order to ensure that services were being provided in a culturally competent manner," Reece said.
He and his team at Positive Impact in Atlanta, Ga., have been implementing a federally funded program to change the way that the HIV-related mental health care system reaches out to ethnic minority populations.
"In research conducted in 2000, we found that African American and Latino individuals were more than 600 times more likely to drop out from mental health care following the first visit to our clinic," Reece said. "Since implementing our new program in 2001 and focusing on the cultural values and norms of our African American and Latino clients, we have almost eliminated the differences in therapy dropout rates that can be explained by ethnicity."
Reece described the role of mental health as being critical to HIV prevention and HIV care.
"We know from research that individuals who are psychologically distressed are more likely to participate in behaviors that can result in HIV infection to others or their own exposure with serious infections. Additionally, we know that psychological distress is related to one's likelihood of disclosing HIV status to others, to adhering to medical regimens, and to maintaining health-promoting behaviors," he said.
Recently, Reece and his team conducted one of the first comprehensive studies of HIV-related mental health in the country of Kenya, in conjunction with the Indiana University-Moi University program called AMPATH (Academic Model for the Prevention and Treatment of HIV).
"It is amazing how similar the mental health issues are between the two countries," Reece said. "The main difference is that Kenya is just now beginning to consider the development of mental health systems," something that he said is critical to the global effort to fight HIV and AIDS. For more information about the Sexual Health Research Working Group, visit http://www.indiana.edu/~shrwg/.
Media Contacts "¢ William L. YarberRural Center for AIDS/HIV Prevention[email protected] 812-855-7974 "¢ Michael ReeceSexual Health Research Working Group[email protected] 812-855-0068
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