On Feb. 25, 2012, the Resolution on Combination Biomedical and Behavioral Approaches to Optimize HIV Prevention (see Exhibit 1) was adopted by the Council of Representatives and became part of official APA policy.

Background

Thirty years after the initial discovery of the virus that causes AIDS, the epidemic continues to spread, both nationally and globally, and it continues to affect millions of individuals across the developmental spectrum (UNAIDS, 2010). Although daunting challenges remain, there have been major advancements in biomedical approaches to reduce HIV transmission during the past 10 years as a result of the increased tolerability and decreased cost of anti-retroviral treatment (ART) and vaccines (e.g., Hepatitis B, HPV vaccine), the expanding range of medical options (e.g., male circumcision, microbicides), and improvement in technological approaches (e.g., female condom). The interest in biomedical approaches has dramatically increased in recent months with the release of findings from the CAPRISA 004 (Karim et al. 2010), the iPrEx (Grant et al. 2010), and HTPN052 [National Institute of Allergy and Infectious Diseases (NIAID), 2011] trials.

South African scientists associated with Caprisa, a Durban-based research center, announced in July 2010 that women who used tenofovir, a vaginal microbicidal gel containing an antiretroviral medication widely used to treat AIDS, were 39 percent less likely over all to contract HIV than those who used a placebo (Weiss et al. 2008). Even more impressive, those women who used the gel most regularly reduced their chances of infection by 54 percent (Karim et al. 2010). In November 2010, scientists associated with the iPrEx (Pre-exposure Prophylaxis Initiative) trial reported that the HIV infection rate in HIV-negative gay men who were given a daily dose of truvada (a pill containing two HIV drugs [tenofovir plus FTC] was reduced by 44 percent, compared with men given a placebo (Grant et al. 2010). In May of 2011, results were released from the HIV Prevention Trials Network (HPTN) 052 study (NIAID, 2011) indicated that initiation of antiretroviral therapy (ART) reduced transmission from HIV+ men and women to their seronegative sexual partners by 96 percent.

For many, the results from these three recent studies constitute “game-changing events” suggesting the need to prioritize biomedical over behavioral approaches to HIV prevention. However, close inspection of the results demonstrates that biomedical approaches to HIV prevention are optimized when they are combined with behavioral approaches. Although biomedical approaches to HIV prevention such as “test-link-and-treat strategies” and pre- and post-exposure prophylaxis are important tools for HIV prevention, in order to optimize prevention outcomes, they must be combined with evidence-based behavioral strategies including structural interventions that increase access to services, decrease costs, and reduce stigma and discrimination to ensure broad-scale implementation (Morin et al., 2011).

The debate over the value of biomedical versus behavioral approaches to HIV prevention can affect funding decisions associated with the implementation of the National HIV/AIDS Strategy (NHAS) released by President Barack Obama in July. The NHAS is intended to guide our national efforts to reduce HIV/AIDS incidence, increase access to care, and reduce HIV-related health disparities.

Resolution on Combination Biomedical and Behavioral Approaches to Optimize HIV Prevention

Whereas recent findings from the CAPRISA 004 trials (Karim et al. 2010) (women receiving Tenofovir gel were 39 percent less likely to contract HIV than those receiving placebo), the Pre-exposure Prophylaxis Initiative (iPrEx) trials (Grant et al. 2010) (HIV-negative gay men given Truvada had 44 percent lower infection rates than men given placebo), and the HPTN 052 trials (NIAID, 2011) (HIV+ individuals initiating ART decreased transmission rates to sexual partners by 96 percent) clearly establish the importance of biomedical approaches to HIV prevention, they do not justify decreased focus or funding for behavioral prevention strategies; and,

Whereas these recent biomedical studies represent significant breakthroughs, combination approaches to prevention of HIV and other sexually transmitted infections (STIs) that comprise both biomedical and psychosocial components work best for optimizing health outcomes (Coates et al. 2008; Piot et al. 2008); and,

Whereas the success of biomedical interventions is dependent on behavioral factors affecting medication adherence and treatment uptake (i.e., treatment acceptability and use) (Weiss et al. 2008); and,

Whereas the efficacy of the CAPRISA, iPrEX, and HTPN 052 studies were optimized by behavioral approaches (Karim et al. 2010; Grant et al. 2010; NIAID, 2011); and,

Whereas women in the CAPRISA study who accessed the adherence counseling program and used the gel most regularly had an HIV infection rate that was 54 percent lower than controls, while those with low adherence had an HIV infection rate that was only 28 percent lower than controls (Karim et al. 2010); and,

Whereas treatment adherence played a central role in the iPrEX study as evidenced by the fact that 91 percent of the men assigned to the treatment group who later tested positive for HIV had no detectable levels of Truvada in their bloodstream (Grant et al. 2010); and,

Whereas behavioral approaches played a central role in the HTPN 052 study (NIAID, 2011) in which all participants were given HIV care that included safe sex counseling; and,

Whereas biomedical interventions for HIV and other STIs without combined behavioral approaches have shown suboptimal medication adherence and treatment uptake [e.g., 80 percent of women do not receive medication to prevent HIV Parent to Child transmission (Temmerman et al. 2003); 80 percent of uncircumcised Zambian males have expressed no interest in considering circumcision as an HIV risk reduction option (Weiss, 2011); only 27 percent of drug users in need of the Hepatitis B vaccine completed the required three dose regimen (McGregor et al. 2003); and only 28.2 percent of young women at a clinic who were offered the human papillomavirus vaccine accepted and of those who accepted only 55.7 percent completed all three required doses (Moor, et al. 2010); and,

Whereas medication adherence and treatment uptake of biomedical interventions can be addressed by behavioral interventions that enhance knowledge and build skills while incorporating attention to factors such as age, socioeconomic status, literacy, religious beliefs, chronic or acute health conditions and disability, developmental understanding, cognitive impairment, race immigration history and status, language, gender, gender identity, sexual orientation, family context, culture, stigma, mental health, substance abuse, attitudes, prior knowledge, etc. (Liebowitz et al., 2011; Underhill et al., 2011); and,

Whereas policy and recommendations have yet to be established as to whether biomedical interventions for HIV prevention will be viewed as life-long or as short-term solutions for high-risk individuals (Paltiel et al., 2009); and,

Whereas successful behavioral engagement in biomedical prevention models may be out of reach for certain populations (e.g., human trafficking victims, sex workers, people living in poverty, children, etc.) necessitating the development of concurrent models that can be accessed by multiple at-risk populations (Bowleg, Neilands & Choi, 2008); and,

Whereas there is insufficient behavioral research to assess the potential for unintended consequences and unanticipated ethical issues in everyday clinical use of HIV biomedical interventions (e.g., individuals might engage in more risky behavior; individuals may not use biomedical agents as prescribed; there may be health disparities in access to biomedical interventions; there may be as yet undefined, long-term, negative health implications and side effects from an exclusive reliance on biomedical interventions; etc.);

Therefore behavioral research is needed to optimize medication adherence and treatment uptake, to document real-world decision making processes associated with biomedical interventions, and to better understand the possible unintended and/or undesired consequences of biomedical interventions; and,

Therefore HIV/STI prevention research teams of the future must bridge biomedical and behavioral approaches and develop new combination approaches that consider biological, cognitive, attitudinal, affective, behavioral, gender, familial, developmental, cultural, educational, social, racial, linguistic, socioeconomic, religious, and environmental factors (Fisher et al., 2010; National Institutes of Health Research Teams of the Future, 2011); and,

Therefore funding should be increased for HIV prevention research that incorporates mental health, substance abuse, behavior change, and adherence strategies to optimize the health outcomes of biomedical strategies with special attention paid to the development of combination prevention interventions that can be accessed by multiple at-risk populations; and,

Therefore Congress, the executive branch, state and local governments, and non-governmental organizations should promote public policies that increase support for multidisciplinary, interdisciplinary and transdisciplinary training, practice, and research; and,

Therefore psychology should continue to be mobilized to conduct research on strategies for improving health outcomes based on behavioral optimization of biomedical approaches to HIV/STI prevention and to continue basic and applied research to identify and disseminate effective universal and selective prevention strategies.

References

• Bowleg, L., Neilands, T.B., & Choi, K. (2008). Evaluating the validity and reliability of a modified schedule of sexist events: Implications for public health research on women's HIV risk behaviors. Women & Health, 47(2), 19-40.

• Coates, T.J., Richter, L., & Caceres, C. (2008). Behavioral strategies to reduce HIV transmission: How to make them work better. The Lancet, 372, 669-684.

• Fisher, J.D., Smith, L.R., & Lenz, E.M. (2010). Secondary prevention of HIV in the United States: Past, current, and future perspectives. Journal of Acquired Immune Deficiency Syndrome, 55(Supple 2), S106-S115.

• Grant, R.M., Lama, J.R., Anderson, P.L., McMahan, V., Liu, A.Y., Vargas, L., Glidden, D.V. (2010). Preexposure chemoprophylaxis for HIV prevention in Men who have sex with men. New England Journal of Medicine, 363, 2587-2599.

• Karim, Q.A., Karim, S.S.A., Frolich, J.A., Grobler, A.C., Baxter, C., Mansor, L.E., Taylor, D. (2010). Effectiveness and safety of tenofvir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science, 329, 1168-1174.

• Liebowitz, A.A.,  Byrnes Parker, K.  & Rotheram-Borus, M.J. (2011). A US policy perspective on oral preexpsoure prophylaxis for HIB. American Journal of Public Health, 101, 982-985.

Passed by APA Council of Representatives 2006

Whereas the primary routes of HIV transmission among injection drug users (IDUs) is the sharing of contaminated injection equipment and unprotected sex; and

Whereas the HIV and hepatitis C epidemics and injection drug use are inextricably linked in American society; and

Whereas injection drug use is associated with one-half of hepatitis C cases and almost one-third of all AIDS cases both through direct transmission through shared needles and indirect transmission through sex with HIV-infected injecting drug users (CDC, 2002 and 2002a); and

Whereas one million active users of injection drugs live in the United States (CDC, 2002b); and

Whereas only a fraction of people who need substance abuse treatment are able to obtain it through public agencies (CDC, 2002b); and

Whereas infected injection drug users (IDUs) transmit HIV through the sharing of contaminated syringes and other drug injection equipment (CDC, 2002a); and

Whereas injection drug users inject approximately 1000 times per year (Lurie, Jones, and Foley, 1998); and

Whereas drug maintenance treatment including methadone maintenance therapy (MMT) and treatment with buprenorphine have been shown to reduce heroin use and drug-related HIV risk behaviors (Sees, Delucchi, Masson et al., 2000; Reynaud-Maurupt et al., 2000; Stock & Shum, 2004; Thiede, Hagan, and Murrill, 2000); and

Whereas participation in MMT is associated with a reduction in the number of sexual partners and a reduction in the number of high-risk partners (Sorensen and Copeland, 2000); and

Whereas participation in MMT is associated with an increase in the use of condoms (Lollis, Strothers, Chitwood et al., 2000), and

Whereas participation in MMT enhanced with harm reduction group therapy is associated with higher rates of abstinence from cocaine and fewer unsafe sexual practices (Avants et al., 2004), and

Whereas participation in MMT or buprenorphine treatment are both associated with reduced HIV risk behaviors (Mattick, Ali, White, O’Brien, Wolk, & Danz, 2003), and

Whereas participation in MMT (Hartel & Schoenbaum, 1998) or buprenorphine treatment is associated with lower rates of HIV infection (Reynaud-Maurupt et al., 2000; Sorensen and Copeland, 2000), and

Whereas participation in MMT provided in primary care settings results in similar HIV risk reduction outcomes as participation in traditional MMT settings (Keen et al., 2003), and 

Whereas drug-free treatments including long-term residential, intensive outpatient, and short-term inpatient treatment for cocaine, alcohol, and polydrug use are associated with significant reductions in drug use and injection risks that lead to the transmission of HIV (Avins, 1997, Gottheil 1998; Hubbard, 1997; Longshore, 1998; McCusker, 1994; 1998; Sorensen and Copeland, 2000), and some of these drug-free treatments also reduce sexual risk behaviors; and

Whereas methadone treatment programs and providers are required to undergo an accreditation and review process that is costly in terms of compliance oversight and funds, and may discourage smaller treatment programs from applying to provide MMT (Department of Health and Human Services, 2001); and

Whereas the Drug Abuse Treatment Act of 2000 allows any physician choosing to take a short specialty training course and become certified to prescribe buprenorphine in an office setting, yet few have done so due to financing and services delivery barriers (West et al., 2004); and

Whereas access to drug treatment including opioid maintenance is particularly difficult in rural areas (Deck & Carlson, 2004) but in general, the availability of drug maintenance treatments for injection drug users is inadequate and discouraged by regulatory requirements;

Therefore be it resolved that the American Psychological Association (APA) actively supports and promotes an increase in accessible, available drug treatment for IDUs in traditional substance abuse, mental health, correctional, educational, and medical care settings in both rural and urban areas to prevent the spread of HIV, hepatitis C, and other contagious diseases.

Moreover,

Given that psychologists have many areas of relevant practice competence, including assessment, intervention, and prevention skills, that could and should inform the discourse about HIV prevention and substance abuse treatment for IDUs and their significant others; and

Given that psychologists’ training in research makes them especially well-qualified to assist policy-makers in making informed judgments based on the best available science;

Let it be further resolved that the APA:

Encourages state governments, Congress, and the executive branch to promote public policies and revise regulations and provide increased training to potential providers to increase available drug treatment for HIV prevention in a variety of settings, and

Promotes increased funding for HIV prevention research that includes drug treatment provided in traditional substance abuse, mental health, correctional, educational, and medical care settings; and

Supports training in HIV prevention interventions, including addiction treatment for injection drug users, within psychology training programs at all levels; and

Promotes and facilitates psychologists’ acquisition of competencies in addiction treatment strategies that decrease transmission of HIV infection among injection drug users that are culturally responsive and gender appropriate, including mastery of the literature on treatment of injection drug users and familiarity with effective interventions that are employed to address this problem; and 

Encourages psychologists to develop multi-cultural competencies that address the issues of sub-groups of individuals, including various racial, ethnic, and gender groups who use and inject drugs; and

Advocates for reimbursement of psychologists for provision of drug treatment interventions that decrease drug-related HIV risk behavior among IDUs; and

Supports psychologists as they engage in interdisciplinary and international efforts involving other health, mental health, and substance abuse professionals who seek to enhance understanding and treatment of drug dependence and sexual risk behaviors.

References

Avants, S.K., Margolin, A., Usubiaga, M.H., & Doebrich, C. (2004). Targeted HIV-related outcomes with intravenous drug users maintained on methadone: a randomized clinical trial of a harm reduction group therapy. Journal of Substance Abuse Treatment, 26, 67-78.

Avins, A.L. , Lindan, C.P. , Woods, W.J. , Hudes, E.S. , Boscarino, J. A., Kay, J., Clark W., & Hulley, S. B. (1997). Changes in HIV-related behaviors among heterosexual alcoholics following addiction treatment. Drug Alcohol Dependence, 44, 47–55.

Centers for Disease Control and Prevention. (2002). HIV/AIDS Surveillance Report. 13, 1-41.

Centers for Disease Control and Prevention (2002a). Fact Sheet Series: Access to Syringes. Retrieved February 25, 2002, from http://www.cdc.gov/idu/facts.htm .

Centers for Disease Control and Prevention (2002b). Fact Sheet Series: Substance Abuse Treatment. Retrieved February 25, 2002, from http://www.cdc.gov/idu/substance.htm .

Centers for Disease Control and Prevention (2002c). IDU/HIV Prevention. HIV Prevention Bulletin: Medical advice for persons who inject illicit drugs. May 9, 1997. Retrieved October 13, 2002 from http://www.cdc.gov/idu/ pubs/hiv_prev.htm.

Deck, D., & Carlson M.J. (2004). Access to publicly funded methadone maintenance treatment in two western states. J Behavioral Health Services Research, 31, 164-77.

Department of Health and Human Services (2001). Opioid Drugs in Maintenance and Detoxification Treatment of Opiate Addiction: Final Rule. Substance Abuse and Mental Health Service Administration, 21 CFR Part 291, 42 CFR Part 8, [Docket No. 98N-0617], RIN 0910-AA52.

Fhima, A., Henrion, R., Lowenstein, W. & Charpak, Y. (2001). Two year follow-up of an opioid-user cohort treated with high-dose buprenorphine. Annals du Medicine Interne, 152, Suppl 3: Is26-Is36.

Hartel, D.M., & Schoenbaum, E.E. (1998). Methadone treatment protects against HIV infection: two decades of experience in the Bronx, New York City. Public Health Reports, 113, 107-115.

Gossop, M., Marsden, J., Stewart, D., & Treacy S. (2002). Change and stability of change after treatment of drug misuse: 2-year outcomes from the National Treatment Outcome Research Study (UK). Addictive Behavior, 27, 155-66.

Gottheil E., Lundy, A., Weinstein S.P., & Sterling, R.C. (1998). Does intensive outpatient cocaine treatment reduce AIDS risky behaviors?. J. Addictive Diseases, 17, 61–69.

Hubbard, R.L., Craddock, S.G., Flynn, P.M., Anderson J. & Etheridge, R.M. (1997). Overview of 1-year follow-up outcomes in the drug abuse treatment outcome study (DATOS). Psychol. Addict. Behav. 11, 261–268.

Keen, J., Oliver, P., Rowse, G., & Mathers, N. (2003). Does methadone maintenance treatment based on the new national guidelines work in a primary care setting? British Journal of General Practice, 53, 461-467.

Lollis, C.M., Strothers, H.S., Chitwood, D.D., & McGhee, M. (2000). Sex, drugs, and HIV: does methadone maintenance reduce drug use and risky sexual behavior? J Behav Medicine, 23, 545-57. 

Longshore, D., & Hsieh, S. (1998). Drug abuse treatment and risky sex: evidence for a cumulative treatment effect? Am. J. Drug Alcohol Abuse, 24, 439–451.

Lurie, P., Jones, T.S., & Foley, J. (1998). A sterile syringe for every drug user injection: How many injections take place annually, and how might pharmacists contribute to syringe distribution? Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology, 18 (suppl 1), S45-S51.

Kwiatkowski, C.F., & Booth, R.E. (2001). Methadone maintenance as HIV risk reduction with street-recruited injecting drug users. J Acquired Immune Deficiciency Syndrome, 26, 483-9.

Magura, S., Rosenblum, A., & Rodriguez, E. M. (1998). Changes in HIV risk behaviors among cocaine-using methadone patients. J Addictive Diseases, 17, 71-90.

Marsch, L.A. (1998). The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behavior and criminality: a meta-analysis. Addiction 93, 515–532.

Mattick, R.P., Ali, R., White, J., O’Brien, S., Wolk, S., & Danz, C. (2003). Buprenorphine versus methadone maintenancne therapy: a randomized double-blind trial with 405 opioid-dependent patients. Addiction, 98, 441-452.

McCusker, J., Bigelow, C., Stoddard, A.M. & Zorn, A., (1994). Human immunodeficiency virus type 1 antibody status and changes in risk behavior among drug users. Ann. Epidemiol. 4, 466–471.

McCusker, J., Willis, G., Vickers-Lahti, & Lewis, B., (1998). Readmissions to drug abuse treatment and HIV risk behavior. Am. J. Drug Alcohol Abuse 24, 523–540.

Prendergast, M.L., Grella, C., Perry, S.M., & Anglin, M.D. (1995). Levo-alpha-acetylmethadol (LAAM): clinical, research, and policy issue of a new pharmacotherapy for opioid addiction. Journal of Psychoactive Drugs, 27, 239-247.

Reynaud-Maurupt, C., Carrieri, M.P., Gastaud, J.A., Pradier, C., Obadia, Y., & Moatti, J.P. (2000). Impact of drug maintenance treatment on injection practices among French HIV-infected IDUs. AIDS Care, 12, 461-470.

Sees, K.L., Delucchi, K.L., Masson, C., Rosen, A., Clark, H.W., Robillard, H., Banys, P. & Hall, S.M. (2000). Methadone maintenance vs 180-day psychosocially enriched detoxification for treatment of opioid dependence: a randomized controlled trial. JAMA, 283, 1303-10.

Sorensen, J.L. & Copeland, A.L. (2000). Drug abuse treatment as an HIV prevention strategy: a review. Drug Alcohol Dependence, 59, 17-31.

Stock, C. & Shum, J.H. (2004). Buprenorphine: a new pharmacotherapy for opioid addictions treatment. Journal of Pain and Palliative Care Pharmacotherapy, 18, 35-54.

Thiede, H., Hagan, H., & Murrill, C.S. (2000). Methadone treatment and HIV and hepatitis B and C risk reduction among injectors in the Seattle area. J Urban Health, 77, 331-45.

West, J.C., Kosten, T.R., Wilk, J., Svikis, D., Triffleman, E., Rae, D.S., Narrow, W.E., Duffy, F.F., & Regier, D.A. (2004). Challenges in increasing access to buprenorphine treatment for opiate addiction. American Journal of Addiction, 13 Suppl 1, S8-16.

Passed by the APA Council of Representatives on February 22, 2005

Whereas the primary route of HIV transmission among injection drug users (IDUs) is the sharing of contaminated injection equipment; and

Whereas injection drug use and the HIV and hepatitis C epidemics are inextricably linked in American society; and

Whereas injection drug use is associated with one-half of hepatitis C cases and almost one-third of all AIDS cases both through direct transmission through shared needles and indirect transmission through sex with HIV-infected injecting drug users (CDC, 2002 and 2002a); and

Whereas one million active users of injection drugs are estimated to live in the United States (CDC, 2002b); and

Whereas only a fraction of people who need substance abuse treatment are able to obtain it through public agencies (CDC, 2002b); and

Whereas infected injection drug users (IDUs) transmit HIV through the sharing of contaminated syringes and other drug injection equipment (CDC, 2002a); and

Whereas injection drug users inject approximately 1000 times per year (Lurie, Jones, and Foley, 1998); and

Whereas ongoing injection-related risk behaviors are associated with restricted syringe access (Gostin, Lazzarini, Jones, & Flaherty, 1997; Rich, Dickinson, Liu, et al., 1998; Broadhead, van Hulst, & Heckathorn, 1999);

Whereas use of needle exchange programs is associated with reductions in reusing syringes, lending used syringes to others, and other indirect sharing activities (Blumenthal et al., 2000; Hagan & Thiede, 2000; Robles et al., 1998; Vlahov, Junge, Brookmeyer, et al., 1997); and

Whereas regular use of needle exchange programs by IDUs is associated with less drug-related HIV risk behavior and lower rates of seroconversion (Des Jarlais, Marmor, Paone, et al., 1996); and

Whereas IDUs who use needle exchange programs have reduced incident hepatitis C virus (Taylor et al., 2000); and

Whereas the incidence of HIV among IDUs who use needle exchange programs is less than one third of the incidence of HIV among IDUs who do not use NEPs (Des Jarlais, 2000); and 

Whereas IDUs who use needle exchange programs exhibit reductions in the mean number of injections per syringe as well as reductions in the mean number of injections per day (Vlahov, Junge, Brookmeyer, et al., 1997); and

Whereas most needle exchange programs provide a range of adjunctive services including primary medical services, HIV/AIDS education, condom distribution, referrals to drug abuse treatment, on-site HIV testing and counseling, and screening for tuberculosis (TB) as well as hepatitis B and C; and

Whereas participation in needle exchange programs is associated with improved access to health care and drug treatment (Strathdee, Celentano, Shah et al., 1999); and

Whereas needle exchange programs have been shown to be cost-effective (Gold et al., 1997; Holtgrave and Pinkerton, 1997, Jacobs et al., 1999); and

Whereas needle exchange programs do not result in increased use of illicit drugs or encourage first time drug use (Robles et al., 1998; Vlahov and Junge, 1998); and

Whereas only about half of the approximately 100 needle exchange programs currently operational in North America are legal (CDC, 2000; Vahlov and Junge, 1998); and

Whereas injection drug users will use sterile syringes if they can obtain them (Junge et al., 1999; Heimer, Khoshnood, Bigg et al., 1998); and

Whereas guaranteed access to sterile injection equipment acquired through pharmacies has been associated with reduced rates of both needle sharing and HIV transmission (Cotten-Oldenburg, Carr, DeBoer, et al., 2001; Weinstein, 1999); and

Whereas a comprehensive policy providing public funding of needle exchange programs, pharmacy sales of syringes, and syringe disposal programs would be cost-effective based on lower costs of caring for newly infected persons with HIV (Holtgrave et al., 1998); and

Whereas access to syringe disposal programs reduces circulation of needles in the community and reduced HIV prevalence in syringes (Kaplan et al., 1994; Riley et al, 1998) and would reduce needle stick injuries to children, sanitation workers, and other community group members (Philipp, 1992); and

Whereas strategies such as needle exchange programs, legal access to sterile syringes at pharmacies, syringe prescription, and safer syringe disposal strategies all reduce the prevalence of unsafe injection drug use practices that lead to the transmission of HIV (Centers for Disease Control and Prevention, 2002a; National Institute on Drug Abuse, 2002; Macalino, Springer, Rahman, et al., 1998; Riley, Beilenson, Vlahov, et al., 1998; Springer, Sterk, Jones, & Friedman, 1999; Kaplan, Khoshnook, & Heimer, 1994; Sulkowski, Ray, & Thomas, 2002; Philipp, 1993); and 

Whereas the US Department of Health and Human Services recommends that all IDUs who continue to inject drugs use a new, sterile syringe for each injection (CDC, 2002c); and

Whereas Congressional bans on the use of federal funds to support needle exchange programs and state laws restricting the sale and distribution of syringes (i.e., through “paraphernalia” statutes, syringe prescription statutes, and pharmacy regulations/guidelines) have the effect of limiting access to sterile syringes and thus constitute substantial obstacles to HIV prevention and public health (Gostin, 1998); and

Whereas the ban on federal funding of needle exchange programs is perhaps the most significant barrier to realizing their potential to prevent disease (NIH Consensus Development Conference, 2000); and

Whereas the availability of drug maintenance treatments for injection drug users is inadequate; and

Whereas many prominent national professional associations have issued public statements that call for action to reduce legal and regulatory barriers that restrict access to sterile syringes in order to help prevent the transmission of contagious diseases ( e.g., American Association of Public Health; American Medical Association, American Pharmaceutical Association, Association of State and Territorial Health Officials, Infectious Diseases Society of America, National Alliance of State and Territorial AIDS Directors, and the National Association of Boards of Pharmacy; American Medical Association, 2002; American Public Health Association, 2002; Infectious Diseases Society of America, 2002);

Therefore be it resolved that the American Psychological Association (APA) actively support and promote HIV prevention strategies such as needle exchange programs, legal access to sterile syringes at pharmacies, syringe prescription, and syringe disposal programs to stop the spread of HIV, hepatitis C, and other contagious diseases.

Moreover,

Given that psychologists have many areas of relevant practice competence, including assessment, intervention, and prevention skills, that could and should inform the discourse about HIV prevention and substance abuse treatment for IDUs and their significant others; and

Given that psychologists’ training in research makes them especially well-qualified to assist policy-makers in making informed judgements based on the best available science;

Let it be further resolved that the APA:

Encourage state governments, Congress, and the executive branch to promote public policies that support harm reduction strategies such as needle exchange programs, legal access to sterile syringes at pharmacies, syringe prescription, and syringe disposal programs, and

Promote increased funding for HIV prevention research that includes a wide range of harm reduction strategies for decreasing transmission of HIV; and

Support training in HIV prevention interventions, including harm reduction interventions for injection drug users, within psychology training programs at all levels; and 

Promote and facilitate psychologists’ acquisition of competencies in harm reduction strategies that decrease transmission of HIV infection among injection drug users, including mastery of the literature on treatment of injection drug users and familiarity with effective interventions that are employed to address this problem; and

Encourage psychologists to develop cultural sensitivity to the sub-group of individuals who use and inject drugs; and

Advocate for reimbursement of psychologists for provision of drug treatment, including provision of harm reduction interventions that decrease drug-related HIV risk behavior among IDUs; and

Support psychologists as they engage in interdisciplinary efforts involving other health, mental health, and substance abuse professionals who seek to enhance understanding and treatment of drug dependence.

References

American Medical Association (1999) HIV Prevention & Access to Sterile Syringes. Retrieved October 1, 2002, from http://www.ama-assn.org/ama/pub/category/1808.html.

American Public Health Association (1994) Syringe and Needle Exchange and HIV Disease. Retrieved October 1, 2002, from http://www.apha.org/legislative/policy/policysearch/.

Blumenthal, R,N., Kral, A.H., Gee, L., Erringer, E.A., and Edlin, B.R. (2000). The effect of syringe exchange use on high risk injection drug users: A cohort study. AIDS, 14(5), 605-611.

Broadhead R.S, van Hulst Y., Heckathorn D.D. (1999). The impact of a needle exchange's closure. Public Health Reports, 114, 439-447.

Bruneau, J., Lamothe, F., Franco, E., Lachance, N., Desy, M., Soto, J., and Vincelette, J. (1997). High rates of HIV infection among injection drug users participating in needle exchange programs in Montreal: Results of a cohort study. American Journal of Epidemiology, 146(12), 994-1002.

Bruneau, J., and Schecter, M.T. (1998). The politics of needles and AIDS. New York Times, April 9, 1998.

Centers for Disease Control and Prevention. (2002;). HIV/AIDS Surveillance Report. 13, 1-41.

Centers for Disease Control and Prevention (2002a). Fact Sheet Series: Access to Syringes. Retrieved February 25, 2002, from http://www.cdc.gov/idu/facts.htm .

Centers for Disease Control and Prevention (2002b). Fact Sheet Series: Substance Abuse Treatment. Retrieved February 25, 2002, from http://www.cdc.gov/idu/substance.htm . 

Centers for Disease Control and Prevention (2002c). IDU/HIV Prevention. HIV Prevention Bulletin: Medical advice for persons who inject illicit drugs. May 9, 1997. Retrieved October 13, 2002 from http://www.cdc.gov/idu/pubs/hiv_prev.htm.

Coffin, P.O., Linas, B.P., Factor, S.H., and Vlahov, D. (2000). New York City pharmacists’ attitudes toward sale of needles/syringes to injection drug users before implementation of law expanding syringe access. Journal of Urban Health, 77(4), 781-93.

Cotton-Oldenburg, N.U., Carr, P., DeBoer, J.M., Collison, E.K., and Novotny, G. (2001). Impact of pharmacy-based syringe access on injection practices among injecting drug users in Minnesota, 1998 to 1999, Journal of Acquired Immune Deficiency Syndrome, 27(2), 183-192.

Des Jarlais, D.C. (2000). Research, politics, and needle exchange. American Journal of Public Health, 90(9), 1392-1394.

Des Jarlais, D.C., Marmor, M., Paone, D., Titus, S., Qiuhu, S., Perlis, T., Jose, B., and Friedman, S. (1996). HIV incidence among injecting drug users in New York City syringe-exchange programs. Lancet, 348, 987-991.

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Gold, M., Gafni, A., Nelligan, P., & Millson, P. (1997). Needle exchange programs: an economic evaluation of a local experience. CMAJ, 157, 255-262.

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Passed by the APA Council of Representatives on February 20, 2005

Whereas the proportion of newly identified HIV cases among persons under 25 has increased since 1994 (CDC, 2002b): and,

Whereas statistical models suggest that half or more of all HIV infections occur before age 25 (Rosenberg et al., 1994); and,

Whereas most of those diagnosed with AIDS at ages 21 to 24 were most likely infected during adolescence as a result of the latency between acquiring HIV and an AIDS diagnosis; and,

Whereas death from AIDS, as well as new cases of HIV, in adolescence disproportionately occurs among females and persons of color (CDC Survey, 2001; U.S. Department of Health and Human Services, 2001); and,

Whereas adolescents are at risk for HIV primarily through their sexual behavior (CDC, 2004a) and males who have sex with males continue to constitute the majority of adolescents living with and/or newly infected with HIV (CDC, 2001; 2002 &c); and,

Whereas approximately 64% of heterosexually acquired HIV infections reported in the United States during 1999-2002 occurred in females and the proportion of HIV-infected females was highest among persons aged 13-19 years (CDC, 2004b); and,

Whereas the following have been identified as risk factors for HIV: early age of sexual debut, more frequent intercourse, less consistent use of condoms, more than four sexual partners, the co-occurrence of a sexually transmitted illness (STI), and anal or vaginal intercourse with an infected partner (CDC, 2002b & c); and,

Whereas in many urban areas of the country a common age of first sexual intercourse among specific subgroups of adolescents is age 12 for males with the national average being age 16 (Aten, et al., 2002; Post & Bokin, 1995; Raine, Jenkins, Aarons, et al., 1999); and,

Whereas one in five young people have sex by age 15 (Albert et al, 2003); and,

Whereas several subgroups of adolescents are at an elevated risk for HIV infection, including adolescents of color, homeless adolescents, males who have sex with males (MSM), gay, bisexual and transgendered adolescents, injection drug using adolescents, victims of sexual abuse, mentally ill adolescents, and adolescents in the juvenile justice or foster care system (Futterman, Chabon, & Hoffman, 2000); and,

Whereas the use of condoms can substantially reduce the risk of HIV infection (CDC, 2003 p. 9; CDC, 1993; Crosby, DiClemente, Wingood, Lang, Harrington, 2003; Macaluso, et al, 1999); and,

Whereas most adolescents who are sexually active do not use condoms consistently (Keller et al., 1991); and,

Whereas young people report concerns about HIV/AIDS, but many do not perceive themselves to be personally at risk and lack accurate information about circumstances that put them at risk for HIV infection (Henry J. Kaiser Family Foundation, 2000); and,

Whereas there is limited evidence for the efficacy of abstinence-only and abstinence until marriage programs with only a few published scientific studies (Thomas, 2000; Denny, Young, Rausch, Spear, 2002) that are quite limited as a result of a lack of randomization and homogeneity of samples, making behavioral change difficult to measure and the results not generalizable; and,

Whereas many published studies associated with abstinence-only education programs (Kirby, Korpi, Barth & Cagampang, 1997; Roosa & Christopher 1990; St. Pierre, Mark, Kaltreider, & Aikin, 1995; Christopher & Roosa, 1990) have failed to find a reduction in sexual behavior; and,

Whereas virginity pledges, abstinence-only programs, and abstinence until marriage programs have been shown to have the unintended consequence of increasing the probability that adolescents will have unprotected intercourse at the time of first intercourse (Bearman & Bruckner, 2001; Bearman & Bruckner, 2004); and,

Whereas virginity pledgers who contracted sexually transmitted diseases (STDs) were less likely to know they had an STD (Bearman & Bruckner, 2004); and,

Whereas abstinence-only and abstinence until marriage programs as a way to prevent HIV transmission have not been shown to be effective in long-term, randomized controlled studies, especially for sexually experienced adolescents (Bearman & Bruckner, 2001; Jemmott, Jemmott & Fong, 1998; Kirby, Korpi, Barth & Cagampang, 1997); and,

Whereas abstinence until marriage programs make no effort to address the unique needs of lesbian, gay, bisexual and transgendered (LGBT) adolescents and thereby discriminate against LGBT adolescents who are disproportionately affected by HIV and who are precluded by law from marrying; and,

Whereas abstinence until marriage programs imply that LGBT adolescents should remain unrealistically abstinent for life because they make no effort to address the unique needs of LBGT adolescents; and,

Whereas abstinence until marriage programs are inherently discriminatory and violate the 1975 APA antidiscrimination resolution on gay, lesbian, bisexual, transgendered and questioning individuals (see http://www.apa.org/pi/lgbc/policy/statements.html#1); and,

Whereas most comprehensive sexuality education programs include the message that abstinence or mutual monogamy with a partner known not to be HIV infected are the safest ways to prevent sexual transmission of HIV and thus support the goals of abstinence and delaying initiation of sexual behavior (CDC, 2003); and,

Whereas HIV prevention programs for youth that focus on delaying initiation of sexual behavior are valuable and justified on the basis of developmental theory; and,

Whereas comprehensive sexuality education programs that provide information, encourage abstinence, promote condom use for those who are sexually active, encourage fewer sexual partners, educate about the importance of early identification and treatment of STDs, and teach sexual communication skills are effective with sexually experienced adolescents (Mullen et al, 2002); and,

Whereas comprehensive sexuality education programs that discuss the appropriate use of condoms do not accelerate sexual debut (Blake, 2003; Guttmacher, et al., 1997; USPHS, Surgeon General 2001) and yet do decrease pregnancy rates (CDC, 2004c); and,

Whereas empirical research shows that comprehensive sexuality education programs decreases the likelihood of unprotected sexual intercourse at the time of first intercourse (Main, et al., 1994; Kirby, 2000; Kirby, 2001) and reduces sexual risk behaviors that contribute to HIV (CDC, 1999; O'Donnell, 2002); and,

Whereas targeted comprehensive sexuality education programs for adolescents have been shown to decrease high risk sexual behaviors among gay, lesbian and bisexual youth (Blake, et al., 2001; Kegeles, Hayes & Coates, 1996; Remafedi, 1994; Rotheram-Borus, Rosario, Reid & Koopman 1995; Rural Center for AIDS/STD Prevention, 2002; Wright, Gonzales, Werner, Laughner, & Wallace, 1998); and,

Whereas targeted comprehensive sexuality education programs for substance dependent adolescents have been shown to, not just decrease high risk sexual behaviors, but to increase the number of adolescents who abstained from sex (St. Lawrence, Crosby , Brasfield & O'Bannon, 2002); and,

Whereas targeted comprehensive sexuality education programs for high risk adolescents in family and community-based institutional settings allow for access to hard-to-reach adolescents and they have been demonstrated to be effective, particularly in increasing condom use and condom acquisition (Harper & Robinson, 1999; Jemmott & Jemmott, 2000; Lightfoot & Rotheram-Borus, 2000; Peterson & DiClemente, 2000); and,

Whereas comprehensive sexuality education programs are effective in reducing risky behaviors and HIV transmission (Rotheram-Borus et al., 1998) and increasing condom use among those having sex for the first time (Rosenfeld, Myer, Merson, 2001; Low-Beer & Stoneburger, 2001); and,

Whereas comprehensive sexuality education programs are effective in preventing high risk sexual behaviors for adolescents living with HIV (Rotheram-Borus, et al., 2001); and,

Whereas a considerable body of evidence shows that comprehensive sexuality education programs focusing on both abstinence and condom use for those who choose to have sex have resulted in reductions in HIV-risk behavior and delays in the onset of intercourse (Collins et al., 2002; Kirby, 2001; Pedlow & Carey, 2001); and,

Whereas current Federal policy and practice in support of abstinence-only programming is based on little scientific evidence (Thomas, 2000) and thus may result in negative consequences for adolescents such as increased pregnancy rates or STDs; and,

Whereas a majority of parents support comprehensive sex education programs for their children (Henry J. Kaiser Family Foundation, 2000); and

Whereas the Institute of Medicine (Ruiz, 2001) and numerous professional and health organizations (e.g., the American Academy of Pediatrics, the American College of Obstetricians & Gynecologists, the American Medical Association, the American Public Health Association, the National Education Association, the National Medical Association, the National School Boards Association, the Society for Adolescent Medicine, Planned Parenthood Federation of America, Advocates for Youth and Sexuality Information and Education Council of the United States) support comprehensive sexuality education programs and recommend the elimination of existing congressional, federal, state and local mandates for abstinence-only and abstinence until marriage programs that censor information about condoms and contraception for the prevention of pregnancy and STDs including HIV; and,

Whereas the Department of Health and Human Services Strategic Plan for Fiscal Years 2002-2008 has as its first goal to prevent the spread of disease and illness, focusing in part on providing education and other materials to reduce unsafe sexual behaviors *U.S. Department of Health and Human Services, Strategic Plan, FY 2003-2008, p. 2); and,

Whereas the Administrations's 2005 budget proposes to double funding to $270 million for abstinence only education programs; and,

Whereas Federal guidelines (Devaney, et al., 2002, p. 31, 34) recommend that programs to prevent HIV/STIs among youth be based on empirical evidence derived from methodologically sound studies characterized by:

a) adequate sampling strategies to ensure minimum selection bias and maximum
generalizability; and,

b) valid and reliable measurement techniques; and,

c) the use of appropriate comparison groups; and

d) pre and post-intervention assessment that includes long-term follow-up to ensure maintenance of intervention effects.

Therefore, be it resolved that the American Psychological Association (APA) strongly supports the foregoing Federal guidelines and further recommends:

that programs to prevent HIV/STIs among youth include clear definitions of the behaviors targeted for change, address a range of sexual behaviors, be available to all adolescents (including youth of color, gay and lesbian adolescents, adolescents exploring same-sex relationships, drug users, adolescents offenders, school dropouts, runaways, mentally ill, homeless, culturally diverse and migrant adolescents), and focus on maximizing a range of positive and lasting health outcomes; and,

that widespread implementation of particular programs occur only in those instances when the efficacy and effectiveness of the programs have been well-established through sound scientific methods; and,

that new programs, including abstinence-only and abstinence until marriage programs, be tested in comparison to programs with proven effectiveness; and,

that public funding for the implementation of comprehensive sexuality education programs be given priority over public funding for the implementation of abstinence-only and abstinence until marriage programs until such programs are proven to be effective.

Be it further resolved that the American Psychological Association supports efforts to:

Educate policy makers about research documenting the limitations of abstinence-only and abstinence until marriage programs, including their failure to attend to the prevention needs of MSM adolescents who are disproportionately affected by HIV/AIDS; and,

Encourage and promote policy makers to base funding decisions and laws on the well-designed scientific research with outcome data measured in terms of pregnancy rates, STIs, and HIV, as well as the health needs of young people, particularly those youth that are at elevated risk for HIV; and,

Urge state governments, Congress, and the executive branch to eliminate censorship of HIV safer sex messages in federally-funded HIV prevention programs; and

Promote comprehensive sexuality education programs designed to prevent HIV; and,

Promote HIV prevention as part of all adolescent mental health and substance abuse treatment and prevention programs; and,

Promote and encourage funding for research and program evaluation initiatives that are directed at youth and families who are at the greatest risk for HIV such as:

• Adolescent males who have sex with males, which remains the highest risk category (CDC, 1995; CDC, 2002c);

• Youth of color and especially young women of color aged 12-19 (CDC, 2004b);

• Adolescents with an early age of onset of sexual activity (CDC, 2002b, c);

• Adolescents with more than four sexual partners (CDC, 2002b,c);

• Runaway and homeless adolescents who engage in "surivival sex." (Stricof, et al., 1990; Shalwitz, et al., 990; Sweeney, et al, 1995; GAO, 1989; Rotheram-Borus, 1991; Rotheram-Borus et al, 1992; Yates, et al., 1988);

• Youth with a history of forced or coerced sex or sexual abuse (Goodenow, Netherland, & Szalacha, 2002; Lyon, Richmond, D'Angelo, 1996; NIMH Multisite HIV Prevention Trial Group, 2001);

• Youth with mental health problems (Brown et al., 1997; Donenberg & Pao, 2004);

• Youth in the juvenile justice system (Teplin, Mericle, McClelland, & Abram 2003);

• Transgendered adolescents (Garofalo et al., 2004);

• Ethnic minority adolescents (CDC, 2002c);

• HIV positive youth (Frederick, et al., 2000; Futterman, et al., 1990; Hein, 1989; Rotheram-Borus, et al., 1997); and

Promote and encourage programs that serve the needs of those whose sexual experiences, by law, occur exclusively outside of the context of traditional marriage, including men who have sex with men, gay, lesbian, bisexual and transgendered youth; and,

Promote training of psychologists in treating youth at risk and to document the need to add this training to all psychology training programs; and,

Promote and facilitate psychologists' acquisition of competencies associated with HIV prevention for youth, including mastery of the literature on HIV prevention and mastery of scientific evaluation of comprehensive sexuality education programs; and,

Encourage psychologists to be especially sensitive to the social and cultural biases which may result in some groups and individuals being underserved by abstinence-only and abstinence until marriage programs, as well as those receiving comprehensive sex education; and,

Work cooperatively with caregivers, families, medical providers, community based organizations, schools and multidisciplinary teams to improve the effectiveness of all programs designed to prevent HIV in youth; and,

Advocate for more rigorous evaluation of abstinence-only programs; and,

Advocate for increased funding for the widespread implementation of family, community and school based HIV prevention programs with proven effectiveness as demonstrated by rigorous evidence-based research.

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Passed by APA Council of Representatives 1996

Whereas American youth are exhibiting behavior leading to increasing rates of life-threatening or health-compromising sexually transmitted diseases that in part reflect ignorance of sexual health promoting behaviors (National Guidelines Task Force, 1991);

Whereas youth infection with HIV/AIDS has reached an epidemic level, particularly among young gay men and ethnic minority youth (National Commission on AIDS, 1993), in part because of lack of knowledge and lack of training about protective behaviors;

Whereas children are becoming involved in sexual activities at younger ages (Ravoira & Cherry, 1992; Singh & Wulf, 1990);

Whereas over one million teenage women become pregnant annually (National Guidelines Task Force, 1991) and approximately 300,000 of these teenagers become homeless or runaways or both (Ravoira & Cherry, 1992);

Whereas the prevalence of sexual intercourse appears to be higher among youth who did not receive sexuality education (Furstenberg & Crawford, 1986);

Whereas youth whose sexual orientation or whose values, beliefs, and practices differ from those deemed acceptable by many in our society are subject to persistent, subtle, or overt harassment and violence which may lead to suicide (Schaecher, 1988);

Whereas youth with a physical or mental disability may be more vulnerable to sexual coercion;

Whereas stranger rape, date rape, sexual abuse, and other forms of sexual violence are traumatic events that have become increasingly prevalent (Koss et al., 1994);

Whereas sexual health, personal self-esteem, and the ability to participate in responsible, caring, and stable relationships, as well as to develop positive interpersonal social attitudes can be promoted through education (Gordon & Schroeder, 1995);

Whereas the American Psychological Association has a necessary and important role in influencing public policy to the benefit and protection of youth in particular and the society in general;

Therefore be it resolved that the APA supports access to information on sexuality as critical to healthy development. Such information should be positive, age appropriate, and culturally suitable, and should respect the choice of abstinence; it should acknowledge women's rights, should foster shared responsibility among males and females for sexual behaviors, and should promote tolerance for sexual diversity; and

Therefore be it resolved that APA public policy support the development and adoption, including research and evaluation, of such comprehensive sexuality education curricula and programs for the promotion of healthy sexual attitudes and behaviors and the prevention and mitigation of endangering and destructive behaviors. It is to be noted that this resolution does not endorse any particular curriculum, procedure, or site for instruction[, but seeks to promote a choice of means for implementing this resolution]. (February 1996)

References

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National Commission on AIDS. (1993). Behavioral and social sciences and the HIV/AIDS epidemic. Washington, DC: Author.

National Guidelines Task Force. (1991). Guidelines for comprehensive sexuality education: Kindergarten-12th grade. New York: Sex Information and Education Council of the U.S.

Ravoira, LaW. & Cherry, A. (1992). Social bonds and teen pregnancy. Westport, CT: Praeger Publishing Co.

Schaecher, R. (1988). Stresses on lesbian and gay adolescents. Independent Schools, 29-35.

Singh, S. & Wulf, D. (1990). Today's adolescent, tomorrow's parent: A portrait of the Americas. N.Y.: Alan Guttmacher Institute.

Passed by APA Council of Representatives 1992

The Board of Directors and Council approved the following resolution:

Whereas one method of transmitting the human immunodeficiency virus (HIV), which causes AIDS, from one person to another is through blood residue in shared drug injection equipment;

Whereas a large proportion of HIV-infected persons are injecting drug users;

Whereas epidemiological projections regarding the future of the AIDS epidemic point to widespread transmission of HIV among injecting drug users and their sexual partners;

Whereas injecting drug users and addicts frequently have limited access to sterile injection equipment on a regular basis;

Whereas the U.S. government has supported very limited AIDS prevention research involving equipment exchange or other means for addicts to acquire sterile injection equipment;

Whereas curtailment of equipment exchange in research projects limits the pursuit of knowledge about the total array of AIDS prevention techniques that may be effective among injecting drug users;

Whereas access to health care systems to acquire injection equipment creates a nexus for offering other services to addicted persons, including health-related education and treatment;

Therefore be it resolved that the APA advocates greatly expanded research, especially demonstration research, on the legal availability of sterile injection equipment as a method of preventing HIV transmission among injecting drug users. Such research should be in the context of also providing other services for drug users, including drug abuse treatment and treatment for HIV infection. (August 1992)

Passed by APA Council of Representatives 1991

Whereas, our nation lacks some of the basic understanding of human sexual behavior necessary to develop effective programs to prevent unwanted pregnancy, sexually transmitted diseases, and HIV infection; and

Whereas, limiting behavioral science and prevention research will result in the spread of sexually transmitted diseases such as HIV infection and the loss of lives; and

Whereas, the Secretary of the Department of Health and Human Services (HHS) has recently announced that he would cancel the funding for this research in response to concerns expressed by conservative political groups; and

Whereas, the HHS Secretary has prevented NIH from conducting a national survey of sexual behavior known as the Survey of Health and AIDS Risk Prevalence (SHARP) for over the past four years due to conservative political pressure; and

Whereas, a recent panel convened by HHS recommended the need to insulate NIH from politics; and

Whereas, federally funded research has profited by the peer-review process at the National Institute of Health (NIH); and

Whereas, the actions of the Secretary pose a major threat to peer reviewed research in the United States;

Therefore, be it resolved that the American Psychological Association:

1. Call upon the Secretary of HHS to reverse his position and continue funding of the adolescent sexual behavior study, and

2. Call upon the Secretary of HHS to promptly approve funding for the SHARP and direct NIH to proceed with their study forthwith,

3. Oppose any Congressional or Administration efforts to restrict federally funded research on sexual behavior; and

4. Protest in the strongest possible terms the threats posed by this action to peer-reviewed research at NIH. (August 1991)

Passed by APA Council of Representatives 1991

The Board of Directors and Council voted to approve the following resolution on legal liability related to confidentiality and the prevention of HIV transmission:
Whereas the status of privileged communication between psychologists and client is legally protected;

Whereas information regarding an individual's HIV status may be particularly sensitive given the personal nature of such information and the potential for discrimination involved;

Whereas providers of psychological services are also concerned about the prevention of HIV transmission and promotion of the public health;

Whereas respect for personal dignity, protection of clients/patients from harm, and promotion of access to mental health services demand protection of confidentiality in all but the most extraordinary circumstances;

Whereas psychological services to HIV-infected individuals make an important contribution to the reduction of risk behaviors that spread such infection;

Whereas legislatures considering exceptions to privileged communications in cases involving HIV infection may benefit from the APA position on this issue;

Therefore be it resolved that APA's position on legislation regarding confidentiality and the prevention of HIV transmission is as follows:

1. A legal duty to protect third parties from HIV infection should not be imposed.

2. If, however, specific legislation is considered, then it should permit disclosure only when (a) the provider knows of an identifiable third party who the provider has compelling reason to believe is at significant risk for infection; (b) the provider has a reasonable belief that the third party has no reason to suspect that he or she is at risk; and (c) the client/patient has been urged to inform the third party and has either refused or is considered unreliable in his/her willingness to notify the third party.

3. If such legislation is adopted, it should include immunity form civil and criminal liability for providers who, in good faith, make decisions to disclose or not to disclose information about HIV infection to third parties. (August 1991)

Passed by APA Council of Representatives 1991

The Board of Directors and Council voted to adopt the following resolution on Neuropsychological assessment and HIV infection:

Whereas concern has been raised that some persons who are infected with HIV or diagnosed with AIDS experience intellectual, cognitive or neuropsychological difficulties;

Whereas many persons with HIV disease and AIDS do not have clinically significant intellectual, cognitive, or neuropsychological deficits;

Whereas establishing the existence of intellectual, cognitive, or neuropsychological impairment requires the use of reliable, valid and appropriate assessments;

Whereas HIV antibody and antigen testing determine only the presence of viral infection;

Whereas HIV serological screening is not a sensitive, specific, or appropriate indicator of intellectual, cognitive, or neuropsychological status;

Whereas determination of functional, intellectual, or cognitive impairment requires a direct psychological assessment of intellectual, cognitive, or neuropsychological status;

Therefore, be it resolved that serological screening for HIV infection cannot be used to assess functional, intellectual, or cognitive impairment. (August 1991)

Passed by APA Council of Representatives 1988

Whereas the epidemic of the Acquired Immune Deficiency Syndrome (AIDS) currently threatens the physical health, mental health, and civil liberties of many persons in American society, and

Whereas, in 1986 the American Psychological Association adopted a comprehensive resolution outlining APA policies surrounding AIDS, including APA's strong commitment to public education regarding AIDS and its prevention, as well as education to combat irrational public fears of AIDS and its transmission, and

Whereas, empirical research has demonstrated that, in addition to imparting knowledge, educational programs designed to effect behavior change should address topics of decision making, risk assessment, attitude change, group norms, and other social and psychological processes, and

Whereas, an important strategy for such education should be to provide children and adolescents of all cultural and socio-economic groups with information about AIDS that is gender-relevant, culturally sensitive, and appropriate to their level of intellectual, emotional and social development, and

Whereas, the U.S. Surgeon General, Dr. C. Everett Koop, has asserted that 'education concerning AIDS must start at the lowest grade possible as part of any health and hygiene program'.

Whereas, effective AIDS education for all age groups must address the behaviors through which AIDS can be transmitted, including but not limited to sexual behavior and sharing of intravenous needles and paraphernalia, and must do so as accurately and explicitly as possible while remaining appropriate to the age and developmental level of the members of targeted audiences, as well as their culture and language,

Therefore, be it resolved that the American Psychological Association supports the Surgeon General's Report on Acquired Immune Deficiency Syndrome (1986),

Be it further resolved that APA urges that information about AIDS, its transmission and prevention be incorporated into elementary and secondary school curricula in conjunction with educational programs concerning sexuality, drug use, health, and family issues; and that such education be provided at the earliest grade possible, and in a manner appropriate to the child's level of intellectual, emotional, and social development. Priority should be given to culturally and linguistically appropriate prevention and education efforts targeted at Black, Hispanic, and Native American youth. The development of such curricula and programs should be accomplished with all deliberate speed by local boards of education, working closely with parents.

Be it further resolved that APA recognizes the importance for AIDS prevention of providing clear and accurate information about sexual behaviors and sharing of needles and syringes, and that the APA deplores attempts by governmental or other institutions to restrict the effectiveness of community-based AIDS-prevention organizations, and

Be it further resolved that the APA urges increased funding from governmental and private sources for basic and applied research and evaluation relevant to AIDS education and risk reduction, and

Be it further resolved that the APA urges its members to provide their expertise to develop, implement, and evaluate AIDS education and risk-reduction programs. (1988)

Passed by APA Council of Representatives 1987

That APA develop recommendations on AIDS prevention within ethnic minority populations and communicate these to public and private agencies conducting AIDS education and prevention programs. (1987)

Passed by APA Council of Representatives 1986

Recognizing that the epidemic of Acquired Immune Deficiency Syndrome (AIDS) threatens the mental health and civil liberties, as well as physical health, of many persons, the American Psychological Association adopts the following resolution:

1. The importance of psychosocial and mental health components of AIDS should be stressed in treatment, research, and prevention programs.

2. APA is also concerned about the public health aspects of AIDS and about he physical and mental health of the public. Therefore APA supports the greater expenditure of public funds for public education regarding AIDS and for the accurate dissemination and utilization of the most current scientific information regarding the prevention and treatment of AIDS.

3. Necessary mental health services and facilities for persons with AIDS, AIDS-related conditions, or an exaggerated fear about the threat of AIDS should be widely available.

4. Given current research evidence that individuals do not become infected with the AIDS virus through casual contact, the American Psychological Association deplores the exclusion of persons with AIDS or those suspected of having AIDS from housing, employment, education, or necessary professional services.

5. The American Psychological Association condemns the use of the AIDS epidemic as a vehicle for fostering prejudice or discrimination against any group or individual.

6. Until there are empirical data linking specific tests with the eventual development of AIDS, the American Psychological Association condemns indiscriminate testing to detect exposure to AIDS.

7. Psychologists are urged to combat irrational public fears of AIDS through education and other professional activities including teaching of courses, lectures to the public, counseling and therapy, consultation, and research regarding the fear of AIDS.

8. Large-scale identification of AIDS seropositive persons, a major public health goal, clearly requires adherence to the requirement of confidentiality of patient records. We urge that this customary ethical tenet be strictly followed in all dealings with persons voluntarily screened for the AIDS virus. (1986)