PETRA: Module 1, Chapter 3

In the beginning of the HIV/AIDS epidemic in the United States, the largest identified risk groups were homosexual and bisexual males (for whom risk of infection was related to having unprotected anal sex and multiple sex partners) and injection drug users (IDUs) who shared infected needles and drug use paraphernalia (“works”),. Other risk groups were hemophiliacs, heterosexual partners of persons with HIV/AIDS, blood transfusion recipients, adults from Central Africa and Haiti, and infants born to mothers who had AIDS or were IDUs (2, 3).

As the epidemic advanced, researchers came to recognize that HIV infection is not limited to social groups bound by language, race, ethnicity, or sexual preference. Risk factors and risk groups vary from setting to setting. Risk behaviors do not occur in a vacuum. Rather, they are shaped by the complex interplay between biological, psychological, social-cultural, population, and demographic factors. As shown in the figure below, these factors combine and interact to both increase and decrease people’s chances of getting (contracting) or giving (transmitting) HIV (5).

Biological and existing health risk factors

There are a number of biological risk factors (both one’s own, and one’s partners) that make it easier for HIV to enter the body. These include: the presence of other sexually transmitted diseases/infections; viral load (often affected by a person’s antiretroviral medication history); immune system health (self or partner); tissue/membrane vulnerability (including tears, lesions, amount of coital lubrication, and mucous membrane health of self or partner); and genetic character of the virus itself (different viral strains) [4].

Psychological factors

Individual psychological factors shape HIV risk behaviors. These include: beliefs about HIV/AIDS, risk perception, personality (including impulsivity and sensation seeking, sexual and physical abuse history, sexual self-control, perceived self-efficacy to use condoms correctly and consistently, self-esteem, risk-taking such as alcohol and other non-injection drug use, etc.), coping styles, communication styles with sex partners, mental health disorders, depression and psychological distress.

Demographic and population-based factors

HIV risk behaviors are shaped in the context of both demographic factors (including race/ethnicity, age, sexual orientation, gender, etc.) as well as population-based factors (e.g., migration; the number of HIV+ people in the population, or “prevalence,” and the frequency of risky behaviors, such as unsafe sex and intravenous drug use, in the population).

Social and cultural factors

HIV risk behaviors are shaped by a variety of social and cultural factors that occur at the level of face-to-face and small group interactions, as well as at the level of institutions, governments and organizations. Examples include inequality, discrimination, stigma, gender roles and constraints, cultural rituals, values, norms, political unrest, economics, individual and social poverty, community transitions, and the availability and accessibility of medical and social services.

References:
1. Smith, Raymond A. (Editor). The Encyclopedia of AIDS: A Social, Political, Cultural, and Scientific Record of the HIV Epidemic. Fitzroy Dearborn Publishers. 1998.

2. Cohen, P.T. Clinical overview of HIV disease. HIV InSite Knowledge Base Chapter. Center for HIV Information, University of California, San Francisco, 1998. Retrieved on February 2, 2004 from http://www.hivinsite.com/InSite.jsp?page=kb-03&doc=kb-03-01-01.

3. Kanki, P.J. & Essex, M.E. The Past and Future of HIV/AIDS. In The Emergence of AIDS: The Impact on Immunology, Microbiology, and Public Health, K.H. Mayer & H.F. Pizer (eds.). Washington, DC: American Public Health Association, 2000.

4. Kalichman, S.C. Preventing AIDS. A Sourcebook for Behavioral Intervention. Mahwah, NJ: Lawrence Erlbaum Associates, 1998.

5. Farmer, P.E., Walton, D.A., & Furin, J.J. The Changing Face of AIDS: Implications for Policy and Practice. In The Emergence of AIDS: The Impact on Immunology, Microbiology, and Public Health, K.H. Mayer & H.F. Pizer (eds.). Washington, DC: American Public Health Association, 2000.