AIDS Exceptionalism: On the Social Psychology of HIV Prevention Research

Abstract

The current analysis considers the HIV prevention research record in the social sciences. We do so with special reference to what has been termed "AIDS Exceptionalism"- departures from standard public health practice and prevention research priorities in favor of alternative approaches to prevention that, it has been argued, emphasize individual rights at the expense of public health protection. In considering this issue, we review the historical context of the HIV epidemic; empirically demonstrate a pattern of prevention research characterized by systematic neglect of prevention interventions for HIV-infected persons; and articulate a rationale for "Prevention for Positives," supportive prevention efforts tailored to the needs of HIV+ individuals. We then propose a social psychological conceptualization of processes that appear to have influenced developments in HIV prevention research and directed its focus to particular target populations. Our concluding section considers whether there are social and research policy lessons to be learned from the record of HIV prevention research that might improve our ability to addresses effectively, equitably, and in timely fashion future epidemics that play out, as HIV does, at the junction of biology and behavior. At the first quarter century of the AIDS epidemic, it is important to weigh our accomplishments against our failures in the fight against AIDS…Future historians will conclude that we cannot escape responsibility for our failure to use effective, scientifically proven strategies to control the AIDS epidemic…They will also likely regard as tragic those instances when we allowed scarce resources to be used to support ideologically driven "prevention" that only served a particular political agenda.Editorial: A Quarter Century of AIDS. American Journal of Public Health. (Stall & Mills, 2006, p. 961).

Figure 1

Hierarchy of intervention subpopulation targets, assigning highest priority to intervention with infected individuals. After Aral, Douglas, & Lipshutz (2007), Behavioral Interventions for Prevention and Control of Sexually Transmitted Diseases.

Figure 2

Publication dates of 15 HIV prevention interventions directed at HIV+ persons included in the B. Johnson et al. (2006) and Crepaz et al. (2006) meta-analyses.

Figure 3

Publication dates of 898 HIV prevention intervention with samples of HIV+, HIV−, and HIV status unknown persons, with any HIV prevention relevant endpoint, 1980–2006.

Figure 4

A preliminary social psychological conceptualization of determinants and processes influencing the development and targeting of HIV prevention research in the social sciences.

Figure 5

Factors affecting the normalization of HIV prevention public health and prevention research priorities.