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The Evolution of HIV Prevention Interventions and Chronic Disease Management

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Principles and Concepts of Behavioral Medicine

Abstract

With the advent of antiretroviral medications, AIDS has transformed from a fatal to a chronic illness. Meanwhile, HIV prevention interventions throughout the world have varied tremendously in both the theories that guide them and the contexts in which they are delivered. Consequently, this chapter (1) selectively reviews approaches to preventing HIV infection and (2) discusses issues surrounding chronic disease management of HIV. It includes key perspectives, such as patient- versus disease-centered approaches and reviews behavior-change theories and models that have been applied to HIV/AIDS along with considerations of diffusion, gender, and power. Among biomedical interventions, it includes antiretroviral prevention, male circumcision, microbicides, and vaccines. It then goes on to discuss the integration of behavioral and biomedical interventions in treatment and to consider treatment as prevention. Among challenges to prevention, the chapter includes adherence to interventions, sexually transmitted coinfections, and risk compensation. Amidst discussion of chronic disease management of AIDS, the chapter includes quality of life, comorbid conditions such as substance use disorders and depression, and stigma. Turning to a global perspective, the chapter examines prevention efforts in the United States, Western and Central Europe, Eastern Europe, and Central Asia, South and Southeast Asia, the Middle East and North Africa, Sub-Saharan Africa, and Latin America and the Caribbean. An emerging challenge is the dissemination of “high impact” approaches that use combinations of effective interventions including antiretroviral treatment for viral load suppression among those at early points in the HIV care continuum. These offer the possibility of a turning point for both HIV-positive and at-risk populations.

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Acknowledgments

Jamila K. Stockman was supported in part by a grant from the National Institute on Drug Abuse (K01DA031593) and the National Institute on Minority Health and Health Disparities (L60MD003701) of the National Institutes of Health. Eileen V. Pitpitan was supported by a grant from the National Institute on Drug Abuse (T32DA023356). The authors also thank Monica Hoffman and Brian Kelly for their assistance. The contents of this chapter are solely the responsibility of the authors and do not necessarily represent the views of the National Institutes of Health.

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Stockman, J.K., Pitpitan, E.V., Patterson, T.L. (2018). The Evolution of HIV Prevention Interventions and Chronic Disease Management. In: Fisher, E., et al. Principles and Concepts of Behavioral Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-93826-4_31

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