Twenty-five years ago, an HIV-positive diagnosis was considered a death sentence. Today, although HIV is still an illness of global concern, it can be a manageable disorder. Through the use of anti-retroviral drugs, people with HIV can live healthy lives for decades. Researchers also continue to remain hopeful that a cure is in sight.
APA has been on the front lines of HIV/AIDS research, prevention, treatment and advocacy since the beginning. Its six-member Ad Hoc Committee on Psychology and AIDS (COPA) was part of its early response, and is celebrating its 25th anniversary at APA's Annual Convention, in Toronto, Aug. 6–9.
"At the time COPA was first created, there were a lot of misconceptions out there, and we didn't have effective tools for prevention or treatment," says Hortensia Amaro, PhD, a professor of social work and preventive medicine at the University of Southern California and a member of an initial task force that recommended COPA's formation. "There needed to be a voice for advocacy and science, and psychologists as a profession had some important contributions to make."
COPA was originally established as an ad hoc committee to guide APA's organizational response to the HIV/AIDS epidemic. But soon after it was established, COPA's role grew to include educating psychologists and society about the unique roles psychology can play in the fight against the virus, such as conducting behavioral research related to medication adherence, providing counseling for newly diagnosed patients and integrating efforts from across psychology disciplines to advance prevention interventions. Today the committee helps to oversee several HIV/AIDS-related programs and initiatives, in addition to providing policy guidance for APA.
The committee's long-term success — it's been reauthorized by APA's Council of Representatives five times — demonstrates the association's commitment to public health and putting research into practice, says Marguerita Lightfoot, PhD, who directs the Center for AIDS Prevention Studies at the University of California, San Francisco, and was a COPA member from 2009 to 2011.
This year's anniversary also comes at a time when many more psychologists are needed in the fight against HIV/AIDS, she adds.
"This slice in time is crucial because the success of any efforts to prevent HIV still hinges on psychological and behavioral aspects. People aren't going to take a pill just because it's available."
Building awareness
In 1986, the U.S. surgeon general's office released its first report on AIDS and AIDS prevention. That same year, APA's then Board of Social and Ethical Responsibility for Psychology (BSERP) convened a committee to discuss developing a task force on psychology and AIDS, which APA's Board of Directors established the next year.
In its 1989 report, the task force recommended that its work in providing policy direction and oversight for APA activities related to AIDS continue through the establishment of an Ad Hoc Committee on Psychology and AIDS. COPA was initially funded for three years with a $5,000 council contingency fund. It initially reported to the council through APA's Board of Directors, though it now reports to the Board for the Advancement of Psychology in the Public Interest.
Since COPA's beginning, much of its work has also been devoted to formulating new APA initiatives to meet the continually changing challenges posed by the epidemic, and advising the staff of APA's Office on AIDS, which was established in 1988 to provide leadership and coordination for APA activities related to HIV/AIDS.
In its early years, COPA focused on increasing education and awareness about how the disorder is transmitted, and on urging psychologists to provide their expertise to develop, implement and evaluate AIDS education and risk-reduction programs.
"There really was a lack of awareness at the time of women who were getting infected, and [the needs of women with AIDS], as well as the cultural and racial diversity of populations affected by HIV and AIDS," Amaro says.
With support from former COPA staff liaison John Anderson, PhD, senior director of the Office on AIDS from 1994 until his death in 2012, the committee helped to establish numerous APA policy positions and statements (see timeline) and to develop APA initiatives to meet the challenges posed by the epidemic.
For example, COPA helped to oversee several federally funded programs administered through the Office on AIDS, including the Cyber Mentor Program, which pairs early career researchers studying HIV among underserved communities with senior researchers for mentoring. COPA members also advised APA on its training programs on HIV/AIDS-related issues. The Behavioral and Social Science Volunteer Program is a national HIV-prevention technical assistance program to support evidence-based HIV-prevention practices in community-based organizations across the country. The HIV Office for Psychology Education (HOPE) Program uses the train-the-trainer model to educate psychologists, psychology students and allied health providers about working with people living with or affected by HIV and has trained 35,000 mental health providers to date.
In addition, in 2012, APA and COPA began collaborating with Black Entertainment Television (BET) and the BET Rap-It-Up Campaignopens in new window, dedicated to informing African-Americans about HIV/AIDS. The partnership sought to develop and implement evidence-based strategies to facilitate positive communication on sex, sexual health, dating and HIV/AIDS among African-American teens and among teens and their families.
COPA members also served as experts on several BET teen forums around the country addressing HIV/AIDS and prevention.
Behavioral health challenges remain
These days, COPA continues to emphasize the importance of behavioral health in HIV/AIDS prevention and treatment. For example, in 2012, in anticipation of the U.S. Food and Drug Administration's approval of the antiretroviral drug Truvada for use in preventing HIV infection, COPA developed a resolution promoting the need to combine behavioral and biomedical approaches to optimize HIV preventionopens in new window. While applauding biomedical innovations, the resolution emphasizes that stopping the epidemic will require prevention approaches that integrate both medical and behavioral strategies, says Eugene Farber, PhD, professor at Emory University School of Medicine and a former COPA member who helped draft the resolution.
"The resolution was significant not just for HIV health policy but also in terms of where APA was moving. It still is in terms of redefining psychology as a health profession and promoting how our expertise in behavior can help to optimize overall health and medical interventions," he says. COPA also developed a 2013 APA resolution that emphasizes the importance of counseling for people being tested for HIV, particularly as home HIV testing grows. In addition, the committee collaborated with other APA committees to organize symposia and journal publications around the care and management of HIV through the aging process. "As HIV treatment got better, people started living longer, so now we have this new cohort of people over age 50 living with HIV," Farber says.
Even though people with HIV are living longer, healthier lives, COPA continues to push its prevention efforts.
"When we look at HIV today, I think there's a misperception that medical advances have taken care of the epidemic," says COPA Chair Matthew Skinta, PhD, director of the Palo Alto University Sexual & Gender Identities Clinic. He notes, however, that many of these biomedical approaches are only available in communities with adequate health resources and access, where neither patients nor providers feel stigmatized discussing these options, and they require a high degree of adherence to be effective.
In addition, Skinta says, despite advances in treatment, 33 states continue to impose criminal penalties on people who know they have HIV and engage in behaviors such as sexual activity without disclosing their HIV-positive status, even if they take precautions to ensure that HIV is not transmitted.
"These laws have been applied without regard for the science, often treating behaviors that are unlikely to transmit the virus, or consensual and agreed-upon behavior between adults, as a misdemeanor or a felony," he says. They also often end up increasing stigma and fear of those living with HIV. In addition, states that criminalize unintentional exposure may be reducing the likelihood that people will be tested and treated, driving up HIV transmission and negative health outcomes.
"With the input and advice of a number of partners from affected communities in HIV advocacy, COPA is working to craft a new APA resolution in opposition to these practices," Skinta says. "Such resolutions provide a touchstone for psychologists to quickly locate empirical data from within the field and to respond within their own communities."
