Strategies for Including HIV/AIDS in Graduate Coursework

Experimental and Didactic Methods in Teaching HIV/AIDS

by Paula Britton
Updated by Kristina Rerucha, MPH (2011)

Relevance of HIV/AIDS Training for Psychologists

Over one million Americans have been diagnosed with HIV/AIDS which raises issues relevant to many fields of study within psychology. Research shows that up to 30 percent of the general population is infected, but unaware of their status. Due to the amount of individuals who are, or may be infected, as well as the number of people affected by a positive status, specialized training on dealing with HIV/AIDS in a therapeutic setting is important. Because of HIV’s profound psychological impact on those living with, and affected by, HIV psychologists should receive specialized HIV clinical management training and education.

As the epidemic has broadened over the past three decades there has been some recognition among psychologists that more trained mental health workers and researchers are needed. Psychologists who have undergone HIV/AIDS training are more willing to treat infected and/or affected clients. They also feel more comfortable with their clients, have more physical contact, and have improved success compared to those with no training. All psychologists should receive training on the medical and psychological aspects of HIV/AIDS in order to effectively work with communities effectively.

Incorporating HIV/AIDS Training into Different Psychological Disciplines

Perhaps the most obvious disciplines that should include HIV/AIDS specific graduate training are health psychology and behavioral medicine. The search for behavioral interventions that successfully improve prevention techniques and incorporate risk reduction methods for positives is vital to helping curb transmission rates. Since psychologists have long focused on behavioral change research, the demand for their expertise has increased. As the field of behavior change has matured, psychology based behavior change approaches have proven to be effective in helping reduce transmission risks.

Similarly, developmental psychologists should be trained on HIV/AIDS issues. Vertical transmission from mother to child has long-reaching impacts upon families and child development. Young people who contract HIV are forced to handle developmental issues out of sequence of the usual developmental stages of youth. Developmental psychologists are key partners in helping the child deal with some of these issues, and their own, unique developmental stages. Additionally, children who have parents with HIV or AIDS not only confront chronic illness and death within their family unit, but they must also confront the possibility of someone else caring for them if their parent dies. Community-based programs that provide services to persons living with HIV or AIDS should seek the input of not only prevention specialists but also specially training community psychology and health psychologists competent in HIV/AIDS related issues.

Due to the increased collaboration between community and social psychologists with health and community workers who together focus on HIV prevention, specially trained HIV/AIDS psychologists have become essential partners in the fight against HIV/AIDS. In fact, a recent survey found that over half of practicing psychologists have treated a client infected with HIV. With increased efficacy of HIV medications, and extended life spans, the needs of HIV-infected clients have shifted. Psychologists play an important role in assisting clients to maintain optimal quality of life.

Faculty Development in HIV/AIDS Issues

A major barrier for incorporating HIV/AIDS training into the classroom setting is that faculty members often lack training in HIV/AIDS-related care. However, when faculty are trained in issues related to HIV/AIDS care, they are more able, and willing, to develop well-articulated and comprehensive goals of their training program which incorporate HIV/AIDS training. In a survey, Campos and his colleagues (1989) found that only 5% of clinical and counseling psychology graduate program faculty reported providing clinical services and only 2% were conducting research related to AIDS. This study has not since been replicated, but anecdotal evidence suggests the number of HIV/AIDS related courses provided have not increased substantially. Further development of HIV/AIDS competencies for graduate faculty is necessary in order to effectively train the providers of the future.

It is understandable that without specialized training themselves, faculties are reluctant to offer HIV-related training to their students. To overcome this barrier, psychology departments should support faculty training to develop specific competencies. Continuing education programs that improve faculty understanding of the HIV epidemic, and how to effectively work with HIV infected or affected clients, should be prioritized among leading psychological departments. Furthermore, collaborative arrangements between clinicians and researchers in related disciplines can help broaden the scope of training provided to both faculty and their students. Collaborative work with community-based HIV service agencies, local and state health facilities, and mental health agencies are avenues that can provide relevant training opportunities for faculty to improve their HIV prevention, treatment, and research competencies while helping create healthier communities.

Adding HIV/AIDS Training to Existing Courses

Though HIV/AIDS specific training for students is optimal, there are several opportunities to add HIV/AIDS training into existing courses. If a new course devoted to HIV/AIDS cannot be added, then developing HIV/AIDS materials to supplement training in existing courses is a solution.

The types of courses in which HIV/AIDS training are most easily integrated into include:

  • Clinical or counseling psychology;

  • Health psychology and behavioral medicine;

  • Social psychology and behavior change;

  • Behavioral medicine;

  • Drug abuse and substance misuse;

  • Racial and minority issues;

  • Community based psychology; and 

  • Human sexuality.

If existing courses already cover too many issues and HIV/AIDS specific training cannot be easily included, incorporating HIV-related case studies or examples that illustrate course content is an alternative approach for exposing students to HIV/AIDS related care issues. Case studies based on HIV treatment methods, client management, familial counseling techniques, or current research can be developed as applied examples of principles being taught in various psychology courses. For instance, in courses that teach principles of behavior and behavior change, you can include examples of behavioral interventions that have been tried in the field of HIV prevention.

In applied courses in clinical or community psychology actual case examples can be developed for training students. For instance, in a clinical psychology training course a profile of a patient with HIV can be added as a counseling case for students to work up. For community psychology courses, analysis of a metropolitan area’s Ryan White Title I Emergency Services plan or a state’s Ryan White Title II HIV Services request to the Health Resources and Services Agency (HRSA) or an HIV Community Prevention Planning proposal to the CDC can be incorporated into the class activities to provide students the opportunity to understand how community-wide planning works. To supplement this activity, copies of plans that have already been implemented from state or city health departments may be requested. Incorporating HIV/AIDS training into classrooms requires a little creativity and time, but the benefits to students, and society, are tremendous.

It is important to note that psychologist self-awareness of bias and attitudes towards working with clients infected with HIV is an integral part to effective care. Incorporating self-assessments or self-reflection activities into the existing courses can help students deal with their own attitudes and biases towards clients of different backgrounds and circumstances. Helping students become aware of these issues before they are in their own practice can positively affect emotions and attitudes of students, and results in more effective care for future clients.

If courses already incorporate HIV/AIDS related issues, faculty may simply be interested in updating their curriculum materials as the effects of the pandemic change. Continuing to be aware of new literature and new approaches related to HIV/AIDS care is important for providing quality training. Collaborating with professors and researchers from different universities, as well as those working directly with HIV/AIDS-infected clients can be beneficial when looking for supplemental materials. The internet has a plethora of quality materials to be used for training and educational purposes.

Incorporating HIV/AIDS training into existing courses does not have to be difficult. If you need assistance, contact the APA Office on AIDS to connect you with psychology departments who are already training their students on HIV/AIDS care.

Developing a Course Focused on HIV/AIDS

For faculty not yet offering HIV-related courses, a major barrier is the length of time that it takes for new course offerings to be approved by departmental curriculum committees. Generally, psychology departments plan their course listings several years in advance. Courses that faculty and accrediting organizations deem important for graduate students to master prior to obtaining a degree are often placed on these lists. However, it is important to not be discouraged by set departmental topics, courses, or seminars. In fact, as noted above, these courses can often have HIV/AIDS training incorporated into them with minimal work. Additionally, departments often have the ability to accommodate experimental courses, such as HIV/AIDS specific courses, as electives.

If there is an opportunity to develop a new course on HIV/AIDS, a number of resources exist to assist with course planning and development. An increasing number of textbooks have been published that provide broad overviews of HIV-related topics and others that focus on clinical treatment and management issues. A comprehensive literature review for topic specific information will provide a great foundation for beginning the development process. The HIV Office on of Psychological Education (HOPE) Program, through the APA Office on AIDS, has a recently updated HOPE Training Resource Package that covers issues for psychologists who work with clients who are infected or affected by HIV/AIDS. The resource package covers topics ranging from HIV transmission information to dealing with disclosure, stigma, death, and a variety of other issues. Material from the resource package was specifically designed to train the work force and can be easily adapted. Additionally, the APA Office on AIDS has compiled a resource list for information seekers. Government agency websites offer additional resources to help develop materials.

One of the best ways to stay up-to-date on issues in the field of HIV/AIDS, other than reading professional journals regularly, is to participate in webinars presented by government agencies, AIDS training centers, or other successful agencies are great sources of information. Some agencies provide archived versions of their webinars to the general public, whereas others provide them only to attendees. Federally funded AIDS Education Training Centers are good places to find topic-specific information. Additionally, being involved in topic sensitive listservs in which information and discussion is an ongoing offers great opportunities to stay abreast of timely information. Colleagues at other universities often readily share reading lists and curricula that would serve a new course developer well and save time. The sharing of case examples and reviews of new books can also help expedite the collection of files to add to library collections.

Developing a new course for HIV/AIDS related topics for psychology students can provide them a unique perspective on working with a variety of people, issues, and communities. Providing students with these competencies can help create healthier individuals, families, and communities.

HIV Competencies for Psychologists

Lara Steleman and colleagues (2008) compiled an "Incomplete list of HIV Competencies for Psychologists". The competencies included on this list are not comprehensive, but do provide guidance for faculty who are attempting to implement HIV/AIDS training into their curricula.

Table 2: An Incomplete List of HIV Competencies for Psychologists
HIV training competency Content domain examples Approach/skill examples
1. HIV medical issues
  • History of HIV epidemic
  • Risk factors
  • HIV testing
  • CD4 & HIV viral load
  • Disease course
  • HIV medications
  • Opportunistic infections
  • Co-infections
  • Medication adherence
  • Barriers to care
  • Health behaviors
  • HIV-associated cognitive impairment
  • Multidisciplinary team participation
  • Consultation
  • Rapid/brief assessment
  • Triage & referral
  • Motivational enhancement
  • Mental health/substance abuse/cognitive screening for medical settings
  • Risk reduction/prevention
  • Neuropsychological testing
  • Pre/posttest counseling
2. HIV psychological issues
  • Stigma
  • Disclosure
  • Safer sex
  • Serodiscordant couples
  • Newly diagnosed
  • Long-term survivors
  • Employment/disability
  • Grief/end-of-life issues
  • Affected family/caregivers
  • Support groups & group psychotherapy
  • Communication skills
  • Problem/solution focused psychotherapies
  • Grief work
  • Career counseling
  • Family systems
3. Common mental health issues
  • Depression & anxiety
  • Chronic mental illness
  • Trauma & PTSD
  • Personality disorders
  • Substance abuse
  • Psychopharmacology
  • Biopsychosocial assessment
  • Cognitive-behavioral strategies
  • Interpersonal psychotherapy
  • Relapse prevention
  • Dialectical-behavior therapy
  • Personality assessment
4. Diversity issues
  • Sexual orientation
  • Gender identity
  • Homophobia & racism
  • SES & poverty
  • Language
  • Religion & spirituality
  • Groups disproportionately affected by HIV
  • Identity exploration
  • GLBT supportive stance
  • Community/family intervention
  • Feminist therapy
  • Culturally-specific approaches
  • Outreach

Stepleman, L. M., Trezza, G. R., Santos, M., & Silberbogen, A. K. (2008). The integration of HIV training into internship curricula: An exploration and comparison of two models. Training and Education in Professional Psychology, 2(1), 35-41.

Student Practicums and Internships

Faculty advisors can assist students in taking advantage of a wide range of opportunities for completing practicums or internships that will give them either a broad overview of HIV/AIDS issues or a focused, in-depth training experience. In every community, state and local health departments, mental health agencies, drug abuse clinics, planning commissions, community-based organizations (CBOs), housing agencies, home care agencies, hospices, and treatment facilities are potential sites for student training.

Some examples of training opportunities for psychology students include:

  • Students may complete a required or voluntary practicum experience by assisting a community-wide planning committee in its development of a state or local HIV prevention plan or HIV services plan.
  • Clinical students may work in out-patient or in-patient settings learning to counsel patients and families who are coping with HIV and AIDS.

As most faculty already know, arranging placements requires that you develop one or more contacts with persons within the agency. Furthermore, it necessitates that a training plan for each student be developed, tailored to the student’s training goals, the agency’s needs, the supervisory requirements, and the length of time of the practicum.

For clinical students who must complete a formal internship, a variety of nationwide placements exist. The Association of Psychology Postdoctoral and Internship Centers (APPIC) Guide to Internship and Postdoctoral Programs in Professional Psychology includes placements in which students will have opportunities for clinical work with patients who are HIV positive. Other students may work at the National Institute of Mental Health (NIMH), the CDC, or other agencies within Department of Health and Human Services (DHHS) to complete training experiences.

Continuing Education and Training Workshops

Continuing education courses and supplemental training workshops are opportunities for faculty, students, and professionals to improve competence within a specific topic area. Whether an individual is offering training opportunities or participating, it is important to develop relevant trainings to help progress the field to better serve HIV infected and affected persons.

Graduate teaching faculty may consider offering opportunities for specialized training on specific HIV-related topics through continuing education seminars, grand rounds at academic medical centers and brief, intensive training workshops. Such intensive training experiences may allow greater flexibility to target training to the latest developments in research. Short courses can be offered to graduate students, alumnae, and practitioners.

The APA HOPE Program is able to provide state-of-the art trainings based on the needs and specifications of the training participants. Contact HOPE today to set up a training for continuing education in a HIV/AIDS related topic, HIV/AIDS ethics, or a training on evidence-based counseling techniques.

For more teaching and clinical resources on practicum training in HIV care please see a Tony Cellucci’s (2010) preferred resources, Practicum Training in HIV Care: Teaching and Clinical Resources.