Even a 100 percent effective pill or vaccine wouldn't necessarily stop the HIV/AIDS epidemic, says Perry N. Halkitis, PhD, chair of APA's Committee on Psychology and AIDS (COPA) and professor of applied psychology, public health and medicine at New York University's Steinhardt School.
That's because biomedical interventions for preventing or treating HIV infection depend on human behavior. And it's why COPA developed a resolution promoting the need to combine behavioral and biomedical approaches to optimize HIV prevention (PDF, 83KB). APA's Council of Representatives approved the resolution in February.
While applauding the success of new biomedical innovations, the resolution emphasizes that stopping the epidemic will require approaches that address both medical and psychosocial issues.
"Anytime you involve human beings — multifaceted, multidimensional, very complex organisms — a simple pill is not going to solve the problem," says Halkitis. "The biomedical approach gives us another weapon, but it's a weapon that will only be maximally effective if combined with what we have learned in the last 30 years about human behavior around the transmission of HIV."
Halkitis points to the drug Truvada, which has been used to treat HIV, as an example. In May, a Food and Drug Administration panel recommended that FDA approve it as a drug to prevent HIV.
"I'm thrilled," says Halkitis. "But I'm also worried about making sure we educate those who are taking the medication to use it properly."
Research shows that patients have trouble adhering to the drug's every-day regimen. Plus, it doesn't exempt people from practicing safe sex, since no pill works all the time.
Failing to adhere to the prescribed regimen can have major consequences for the person and for society as a whole, Halkitis adds.
"Missing or skipping doses gives the virus an opportunity to mutate," he says. "That's a problem not only for the person taking the pills but for the individuals they may be having unsafe sex with, since they may be passing on a resistant version of the virus."
APA's resolution calls for more research on behavioral factors such as people's willingness to start and stick with treatment, medication adherence and decision-making, and the development of new prevention approaches that combine biomedical and behavioral advances. The resolution also recommends increased funding for prevention research that incorporates mental health, substance abuse, behavior change and adherence strategies, plus policies that promote training, practice and research across disciplines.
To get the word out, Halkitis and Leo Rennie, senior legislative and federal affairs officer in APA's Public Interest Directorate, headed to Capitol Hill and beyond.
They met with Grant Colfax, MD, the new director of the White House Office on National AIDS Policy, plus a staffer for the Senate appropriations subcommittee responsible for research funding. They also visited Ronald O. Valdiserri, MD, deputy assistant secretary for health and infectious diseases at the U.S. Department of Health and Human Services, who used APA's resolution as the basis of his talk at the "Advancing the National HIV/AIDS Strategy in Metropolitan Washington" conference the following day.
The response at all three meetings was excellent, says Halkitis.
—Rebecca A. Clay
Letters to the Editor
- Send us a letter