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,
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).
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) .
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.
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).
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.
1. Smith, Raymond A. (Editor). The Encyclopedia of AIDS: A Social, Political,
Cultural, and Scientific Record of the HIV Epidemic. Fitzroy Dearborn
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
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.
Sociometrics Corporation, 2004