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Abstinence Only Programs
While abstinence is the only fool proof way to avoid HIV infection, research has shown that few people choose it. There is evidence that about 7% of students are sexually active before the age of thirteen, with almost 70% active by age eighteen (Cavaos-Rehg et al., 2009). Older adults are also sexually active at an older age, some with multiple partners (Foster et al., 2010).
Risky behaviors for HIV are not the only heath warnings we in the US choose to ignore. For example, an estimated 47 million people currently use tobacco products in the US, including 23% of adults and 30% of adolescents. Tobacco is the cause of about 400,000 preventable premature deaths each year. This data underscores the reality that people choose to ignore health risks everyday. While abstinence may be an ideal form of prevention, it should be only one component in a more comprehensive program providing numerous options for behavior change and prevention.
Vaccines
Historically, vaccine administration has promoted the development of antibodies in the human immune system allowing us to mount an effective defense against infections. HIV is a difficult target and has to date eluded any attempts at effective vaccine development. The first HIV vaccine clinical trail opened at the National Institutes of Health in 1987 with discouraging results (NIH, 2012). While vaccine remains an elusive option for HIV prevention, once developed many obstacles will still need to be overcome before it is available to the majority of people in developing countries where the epidemic is the most prevalent.
Stigma and Discrimination
According to Erving Goffman (1963), stigma is an attribute assigned by society to separate “normal” from “abnormal” or “us” from “them.” Stigma can be attributed to a behavior or attribute considered deviant by society. People infected with HIV/AIDS have been stigmatized since the beginning of the epidemic. Once considered a “gay men’s disease,” the stigma continues even now when it has affected people in all walks of life.
Stigma and discrimination hurt those who are targeted. When asked why people at known risk for HIV refuse testing, the most common answer is that they fear the stigma associated with the disease. Some people do not want their insurance companies to know they are concerned about being infected with HIV so avoid testing for fear that doing so would result in being dropped from their health care coverage. Others fear the reaction of family and friends or loss of employment or housing.
When HIV was first discovered caution was understandable since neither the cause or treatment of the deadly disease was known. Today our knowledge is more complete regarding routes of transmission and treatment. We know we can’t be infected by casual contact, sneezing, sharing utensils, mosquito bites or sharing toilets. HIV infection only occurs after exposure to blood or bodily fluids of someone who is infected or by maternal/fetal transmission.
Mahajan et al. (2009) conducted a literature review of HIV related stigma. They concluded that stigma continues to be a major barrier to effective responses to the HIV/AIDS epidemic, yet stigma reduction efforts are relegated to the bottom of AIDS program priorities locally, nationally and globally.
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