Feature

The AIDS epidemic probably won't peak until 2050. A vaccine for HIV may be 20 years away. The disease is devastating populations in sub-Saharan Africa, leaving 12 percent of the children in the region parentless. And, ironically, thanks to antiretroviral and other drug treatments, many people no longer perceive AIDS as an immediate death sentence, and HIV infection rates are rising again in the United States.

These were a few of the issues Thomas Coates, PhD, highlighted during his address at APA's 2002 Annual Convention in Chicago. Coates, director and principal investigator of the Center for AIDS Prevention Studies and a professor of medicine at the University of California, San Francisco, outlined the major challenges of HIV/AIDS and encouraged psychologists to help fight the disease.

"HIV needs psychology," said Coates. "Research is essential in the areas of prevention, adherence, stigma, and removing policy barriers to prevention and care--as well as in areas such as gender inequality and homophobia, as these are the driving causes of the epidemic."

Clinical and counseling psychologists can make a difference, too, by "providing sensitive and competent services to people with HIV or who are at risk of getting HIV," said Coates. Practicing psychologists also can advocate for more evidence-based treatment and prevention programs. In fact, with some scientists saying that a preventive vaccine may be theoretically impossible, prevention remains the only sure way to stop the spread of HIV/AIDS, he added.

Psychologists' expertise is also critical for tackling another challenge to AIDS prevention: illegal drug use. "We've known for a long time that drug abuse and use can be a driving force in the epidemic," said Coates. "The introduction of party drugs, like ecstacy, has led young people particularly to engage in risky practices," he said. "We also know in the gay community that crystal methamphetamines lead people to be hypersexual and to engage in activities that will transmit HIV."

Making matters worse, some men are now mixing crystal methamphetamines--which can cause erectile dysfunction--with Viagra, Coates reported. "With Viagra, you have the counterbalancing effect, so that people can have quite a bit of hypersex. And with the evolution of the Internet, you can order Viagra within 20 minutes."

Disparities in treatment are another major HIV/AIDS challenge, said Coates. "When the history of this epidemic is written, one of the things that they can commend the United States for is its huge investment in HIV science....But we are doing absolutely genocidal acts with our own population and with populations around the world."

For example, a 1985 to 1999 study of U.S. AIDS cases by race and ethnicity showed that infection rates for whites went down, while infection rates for African Americans and Latinos went up. The study also found that AIDS deaths decreased among whites but increased among blacks and Latinos. These statistics suggest that whites benefited more from antiretroviral and combination drug therapies and from prevention programs than did other groups, Coates reported.

Meanwhile, more than 28 million Africans are living with HIV, and in some African countries more than 30 percent of adults are infected with the virus, according to the United Nations. "A huge challenge will be to see if we can turn [the epidemic] around" in Africa, as well as in other developing countries, Coates said.

But beating these HIV/AIDS challenges will take increased financial commitment from the federal government, which Coates worries is waning in the wake of 9/11.

"We have now moved on to terrorism. Sept. 11 was a bad day--3,500 individuals died," he acknowledged. But he added that about 8,300 people die every day from HIV/AIDS, "and yet the world does not seem to notice or care."