HIV/AIDS rates are skyrocketing among the traditionally underserved, despite the millions spent on education programs by the Centers for Disease Control and Prevention, says sexual health researcher Gail Wyatt, PhD, of the University of California, Los Angeles (UCLA).

Wyatt includes among the underserved highly religious people, married women, seniors, teenagers and men who have sex with men but don't self-identify as homosexual. Wyatt cites three reasons to include married women as underserved, including they don't think they're at risk; most don't know if their partner is having sex outside of the relationship; and unprotected sex is endorsed for procreation.

Psychologists need a better understanding of human sexuality to design effective preventive education, says Wyatt, the first African-American woman licensed as a clinical psychologist in California and director of UCLA's Center for Culture, Trauma and Mental Health Disparities.

"There's a gap between what we think we're doing and may feel needs to be done, and what people actually need in order to effectively change their behavior," says Wyatt, who will discuss her work in HIV/AIDS prevention in the plenary session "You Should Know What I Know: The Empirical Basis for Understanding Sex Today," 11 a.m., Aug. 18, at APA's 2007 Annual Convention in San Francisco.

Many risk-reduction interventions fail because they try to teach sexually responsible behavior almost like an etiquette lesson of eating with the correct fork, Wyatt points out. But when it comes to sex, that's not how people behave, she says.

"You select your own fork in sex, based on your experiences and what's been pleasurable to you, and no one's really been able to effectively change that selection process because it is as biological as it is psychological as it is skills-based," Wyatt explains.

To encourage greater condom use and fewer sexual partners, Wyatt says interventions must consider a person's overall mental health, and factors like depression, post-traumatic stress disorder and history of sexual abuse as well as a person's sexual behavior, sociocultural background and desire to have children, she says.

She will describe several evidence-based, culturally congruent interventions that she helped to design that acknowledge strengths and values within African-American culture to promote personal responsibility and cut transmission risk among African-American couples with one HIV positive partner. Above all, psychologists need to help the public understand a concept of sexual health that includes protection along with pleasure, Wyatt says.

"I think that's where we're stuck," says Wyatt. "People want to know what to do to attract a certain type of partner, and I'm trying to help them stay alive."

-C. Munsey