001

Table of Contents
 
Title Page
Copyright Page
Dedication
Foreword
Preface
ACKNOWLEDGMENTS
REFERENCES
About the Editor
About the Contributors
 
PART ONE - HIV BASICS AND SOCIAL WORK PRINCIPLES
 
Chapter One - HIV HISTORY, ILLNESS, TRANSMISSION, AND TREATMENT
 
THE EMERGENCE OF HIV IN THE UNITED STATES
EPIDEMIOLOGY: STATISTICS AND POPULATIONS IN THE TWENTY-FIRST CENTURY
BIOLOGICAL ASPECTS OF HIV
HIV TESTING
HIV TRANSMISSION
TREATMENT
HIV PREVENTION
CONCLUSIONS
REFERENCES
 
Chapter Two - UNDERLYING PRINCIPLES OF HELPING IN THE HIV FIELD
 
SOCIAL JUSTICE
DIGNITY AND WORTH OF THE PERSON
THE IMPORTANCE OF HUMAN RELATIONSHIPS
HUMAN RIGHTS
CULTURAL COMPETENCE
EMPOWERMENT
STRENGTHS PERSPECTIVE
INVITATION TO SOCIAL TRANSFORMATION
INVITATION TO COMPASSION
INVITATION TO HOPE AND WITNESS
ETHIC OF CARE
CONCLUSIONS
REFERENCES
 
Chapter Three - CULTURAL COMPETENCE AND HIV
 
DEFINITION OF CULTURAL COMPETENCE
THE SIGNIFICANCE OF CULTURAL COMPETENCE IN HIV PREVENTION AND TREATMENT
CULTURAL COMPETENCE AND HIV: A LITERATURE REVIEW
CULTURAL COMPETENCE FRAMEWORKS
IMPLICATIONS FOR PRACTITIONERS
CONCLUSIONS
REFERENCES
 
Chapter Four - THE HUMAN RIGHTS FRAMEWORK APPLIED TO HIV SERVICES AND POLICY
 
HUMAN RIGHTS FORMALIZED AND DECLARED
THE HUMAN RIGHTS FRAMEWORK
HUMAN RIGHTS IN RELATIONSHIP TO HIV PRACTICE AND POLICY
SOCIAL WORK, SERVICES, AND AGENCIES THROUGH THE HUMAN RIGHTS LENS
TESTING AND PREVENTION THROUGH THE HUMAN RIGHTS LENS
MEDICAL CARE AND MEDICINE THROUGH THE HUMAN RIGHTS LENS
CONCLUSIONS
REFERENCES
 
PART TWO - SOCIAL WORK PRACTICE
Chapter Five - HIV-RELATED CASE MANAGEMENT
 
HIV CASE MANAGEMENT
A MODEL OF CASE MANAGEMENT: JRI HEALTH
CASE MANAGER INTERVIEWS
CONCLUSIONS
REFERENCES
 
Chapter Six - HIV-RELATED CRISIS INTERVENTION AND COUNSELING
 
PREVENTION COUNSELING
TO TEST OR NOT TO TEST
NOW WHAT? COPING AND LIVING WITH HIV
CONCLUSIONS
REFERENCES
 
Chapter Seven - HIV SOCIAL WORK ROLES, TASKS, AND CHALLENGES IN HEALTH CARE SETTINGS
 
THE VALUE OF ANCILLARY SERVICES
GENERAL TASKS OF A SOCIAL WORKER IN HEALTH CARE
THE ROLE OF A SOCIAL WORKER IN ASSISTING PERSONS LIVING WITH HIV
THE HEALTH CARE SYSTEM AND SETTINGS FOR HIV SOCIAL WORK
CONSIDERATIONS FOR ALL HEALTH CARE SETTINGS
CHALLENGES IN WORKING WITH PERSONS WITH HIV IN TODAY’S HEALTH CARE SYSTEM
END-OF-LIFE CARE
CONCLUSIONS
REFERENCES
 
Chapter Eight - HIV-RELATED GROUP WORK AND FAMILY SUPPORT
 
GROUP WORK
FAMILY SUPPORT
HIV PREVENTION AND EDUCATION
THE ROLE OF TRAUMA IN HIV CARE: THE IMPACT ON THE SOCIAL WORKER
CONCLUSIONS
REFERENCES
 
Chapter Nine - ADMINISTRATION OF HIV SERVICES: PROGRAM DEVELOPMENT, MANAGEMENT, ...
 
THE CHALLENGE OF A CHANGING FIELD
SOCIAL WORK MANAGER SKILLS IN AN ASO
CONCLUSIONS
REFERENCES
 
Chapter Ten - HIV-RELATED COMMUNITY ORGANIZING AND GRASSROOTS ADVOCACY
 
WHAT IS THE CONTEXT FOR HIV COMMUNITY ORGANIZING?
A CONCEPTUAL FOUNDATION FOR HIV-RELATED COMMUNITY ORGANIZING
Case Study: Creating Legal Syringe-Exchange Programs in Detroit Michigan: ...
CONCLUSIONS
REFERENCES
 
Chapter Eleven - HIV-RELATED POLITICAL AND LEGISLATIVE INTERVENTION
 
SOCIAL WORKER AS CHANGE AGENT
WHAT ARE SOME OF THE KEY ISSUES IN LEGISLATIVE ADVOCACY?
HOW DOES THE SYSTEM WORK?
LEGISLATIVE ADVOCACY
SOCIAL WORK RESPONSE
CONCLUSIONS
REFERENCES
 
Chapter Twelve - HIV PREVENTION INNOVATIONS AND CHALLENGES
 
HIV INCIDENCE IN THE UNITED STATES UNCHANGED
HIV TESTING
VAST ETHNIC AND RACIAL DISPARITIES IN HIV
GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WITH MEN (MSM)
CHAPTER GOALS
COMBINATION PREVENTION
CONCLUSIONS
REFERENCES
 
PART THREE - SPECIFIC VULNERABLE POPULATIONS
Chapter Thirteen - WOMEN AND HIV IN THE U.S.: FROM INVISIBLE TO SELF-DETERMINED
 
A SNAPSHOT OF WOMEN AND HIV RISK
WOMEN’S SOCIOECONOMIC AND CULTURAL VULNERABILITY TO HIV
APPROACHES TO HIV PREVENTION AND CARE
CONCLUSIONS
REFERENCES
 
Chapter Fourteen - HIV PREVENTION AND SERVICES FOR GAY, BISEXUAL, AND OTHER MEN ...
 
MULTIPLE LEVELS OF RISKS FOR GAY AND BISEXUAL MEN
HIV PREVENTION FOR GAY AND BISEXUAL MEN
SERVICE PROVISION FOR GAY AND BISEXUAL MEN
RECOMMENDATIONS FOR PRACTICE AND ADVOCACY
CONCLUSIONS
REFERENCES
 
Chapter Fifteen - THE IMPACT OF HIV ON CHILDREN AND ADOLESCENTS
 
THE HIV TRAJECTORY
SERVICES AND SUPPORT FOR CHILDREN AND ADOLESCENTS AND THEIR FAMILIES
CONCLUSIONS
REFERENCES
 
Chapter Sixteen - HIV-INFECTED AND HIV-AFFECTED MIDLIFE AND OLDER PERSONS
 
CHANGING DEMOGRAPHICS
DIVERSITY IN HIV OR AIDS AMONG OLDER ADULTS
DISTINCT POPULATIONS
CONCLUSIONS
REFERENCES
 
Chapter Seventeen - HIV AND BLACK AND AFRICAN AMERICAN COMMUNITIES IN THE ...
 
HIV AND AIDS IN THE U.S. AFRICAN DIASPORA
THE PROBLEM WITH PREVENTION STUDIES: AN INDIVIDUAL FOCUS
SOCIAL STRUCTURE, SOCIAL CONSTRAINTS, AND HIV DISPARITIES
INCARCERATION, INCOME SUPPORT POLICIES, AND THE LABOR MARKET
BLACK AND AFRICAN AMERICAN WOMEN AND HIV AND AIDS
EVIDENCE-BASED HIV PREVENTION INTERVENTIONS AND HETEROSEXUAL BLACKS AND AFRICAN AMERICANS
CONCLUSIONS
REFERENCES
 
Chapter Eighteen - LATINOS AND HIV: A FRAMEWORK TO DEVELOP EVIDENCE-BASED STRATEGIES
 
HIV AND AIDS AMONG LATINOS
PLANNING EFFECTIVE PREVENTION AND TREATMENT PROGRAMS
THE ROLE OF SOCIAL WORKERS IN PROMOTING HIGHLY ACTIVE HIV PREVENTION FOR LATINOS
CONCLUSIONS
REFERENCES
RESOURCES FOR SOCIAL WORKERS AND HUMAN SERVICES PROFESSIONALS
 
Chapter Nineteen - HIV-AFFECTED CAREGIVERS
 
WHY CARE ABOUT CAREGIVERS?
A CLOSER LOOK AT HIV CAREGIVERS: WHO THEY ARE
CONCLUSIONS
REFERENCES
 
Chapter Twenty - AFTERWORD: LOOKING BACK, LOOKING FORWARD IN HIV SOCIAL WORK
 
LOOKING BACK
LOOKING FORWARD
THE PROFESSION
CONCLUDING REMARKS
 
Author Index
Subject Index

001

To all the people living with HIV who have taught us all so much about living.

Foreword
Throughout the history of the HIV pandemic in the United States, a vast number of professionally trained social workers have provided critical psychosocial care to those infected or affected. However, there have been few HIV and AIDS textbooks, handbooks, or other published works that have been written by and for social workers. It has been a decade since the last such published contribution was released. Clearly, such a volume is long overdue. Many of us who authored or edited earlier social work HIV and AIDS volumes have either retired from our professional work or are close to retirement age. Other HIV social workers need to build on our earlier contributions. Now is the time to pass the baton to a new cadre of men and women who can advance the HIV knowledge base for social work practice, policy, education, and research.
Cynthia Cannon Poindexter has taken that baton and given us a remarkable edited volume that contains much information on HIV that every professional social worker needs to know in order to practice competently in today’s complex world. Certainly, for the social worker committed to HIV social work practice as a specialty area, this volume is a must-have for one’s professional library. I believe it will be the leading text that guides our work in this country for at least the next 5 to 10 years.
This important book is crisply organized and begins with four chapters that outline the basics of the disease and their relationship to social work practice (Part 1). We then are presented with a rich set of chapters that address the important and diverse HIV-related roles and tasks in which social work is involved in HIV service delivery (Part 2). The book concludes with several chapters that address very specific service delivery needs and practice approaches in working with those most vulnerable to HIV disease (Part 3).
In my role as founder and chair of the Annual National Conference on Social Work and HIV (in its twenty-second year as I write) I witness each year the hunger that our colleagues from across the country have for continuing education offerings that are produced by and for HIV social workers. Our extensive and diverse conference presentations each year fill that need to some degree, but they are not enough. Such offerings need to be augmented by various published works such as this one that will keep us informed and current about the ever-changing aspects of HIV practice today. This important book will help a great deal in addressing many of those unmet social work continuing education needs now and for the next several years of the pandemic. It will also provide inspiration for some of our younger colleagues to add to our knowledge base by writing other important contributions in the not too distant future. Many of the chapter contributors are longtime friends and social work colleagues who, like me, have worked in HIV since the early years of the pandemic. Others have more recently entered the field. All have in common the same degree of passion and commitment to this important work. This handbook builds a critical intergenerational bridge by linking tomorrow’s leaders in HIV social work practice, policy, education, and research with those mentors who are rich with many years of practice wisdom. I commend the editor and all chapter authors for this much-needed and excellent addition to our HIV social work knowledge base.
Vincent J. Lynch, MSW, PhD
Boston College Graduate School of Social Work

Preface
This handbook on HIV-related social services is intended for social work and human services practitioners, managers, advocates, and students. We hope it is also useful for HIV-infected and HIV-affected persons. The chapter authors, all of whom have been involved in the HIV field for years as advocates, educators, case managers, counselors, or administrators, hope that their contributions will address the current realities of the HIV pandemic in North America almost 30 years after the disease was identified.
It is a shock for old-timers in the HIV field to meet young adults—as students, coworkers, friends, and neighbors—who have never known a world without HIV. We realize with disbelief that HIV is no longer the new disease that once captured the world’s attention and became a focal point for the public’s fears and prejudices. What happened to that “new emergency” we jumped to address? It seems to have grown old with us and to have become routine. Even though HIV has been around long enough to seem commonplace, we still know without a doubt that it cannot be taken for granted; it cannot be ignored. Even though HIV is becoming integrated into mainstream health and social service organizations, we know that the response to it cannot be like the response to anything else. HIV is not exactly like any other physical condition or social problem. The HIV pandemic is unlike any other health phenomenon in recorded history. Science has known of no other infectious, life-threatening, blood-borne, and sexually transmitted disease that destroys the body’s immune system, whose symptoms remain hidden for years, and that keeps the host alive long enough to spread the agent far and wide. Social science has not recently dealt with a disease as hidden, highly stigmatized, and full of religious, political, societal, economic, behavioral, or cultural barriers to ameliorating it. HIV calls for responses and skills that are HIV-specific. This handbook strives to begin to address those issues. Now that it is clear that the pandemic will be with us for many decades to come, what should the service, prevention, and advocacy responses be in light of what we now know?
We have seen two different HIV pandemics in the developed world. During the first 15 years or so, before the advent of combination antiretroviral therapy, the social service and social action response was to an extreme emergency. Everyone operated in crisis mode, needing to create systems and practice models quickly, yet still hoping that a vaccine and a cure would be soon developed. In the earliest years, most efforts were made by small community-based advocacy organizations run by people directly affected by HIV and their allies. In the second 15 years of the pandemic, the medical progress made in a relatively short period of time in developed countries has been amazing: Death rates from HIV have plummeted. Advancements in treatment have shifted the required service and advocacy responses away from crisis intervention to a more traditional long-term approach.
Still, over the past decade some new challenges have appeared. One challenge has been that a social service system originally developed to address acute needs, crises, and death has struggled to adapt rapidly enough to the realities of today’s pandemic, which comprises an ever-growing number of people who are living longer and longer with more and more chronic conditions. As Peter Piot, the former head of UNAIDS, has stated, we must shift “from crisis management to sustained strategic response” if we are to address the pandemic in its third decade (2006, p. 526). A second challenge has been that the availability of, competition for, and reliance on federal and state funding has led many HIV organizations to become more bureaucratic and less aligned with the infected and affected communities. Third, early prevention strategies were based on the reality that most people with HIV did not live long, and thus they focused on short-term changes in individual behavior to disrupt further spread of the virus in the hope that a vaccine or cure would be around the corner. We were therefore not prepared to offer realistic, alternative safer sex messages when advances in medical treatment led to a much longer life expectancy and everyone with HIV realized they were expected to modify their sexual and injecting behavior for decades. Fourth, we are challenged by a popular view that HIV is now manageable and “no big deal” due in large part to pharmaceutical advertisements that foster the myth of a cure. These realities, along with media silence, public and political apathy, and educational failure, have created a recipe for continued disaster.
In a changing HIV landscape, some things do appear constant: HIV stigma still keeps people from getting tested and disclosing their HIV status to each other; universal access to treatment still seems a distant dream; it is clear that there will probably be no cure; the federal government still refuses to fund syringe exchange programs; developing a vaccine seems to be impossible; and our efforts toward prevention have fallen alarmingly short. Even though the amount of attention given to HIV may convince some that the problem is under control, that is far from true: More people are living with HIV now than ever before; 25% of those who are infected in the United States do not know that they have HIV; and 45% of those newly diagnosed with HIV have tested positive so late in their disease process that they progress to AIDS within three years of their HIV diagnosis.
The book is structured in three sections, which parallel the subtitle: Principles, Practices, and Populations. The first section—on principles—lays the groundwork necessary to understand all HIV services, advocacy, and prevention. Chapter 1 is an overview of the disease: history, transmission, disease process and progression, testing, medication and side effects, and adherence support. Chapter 2 outlines the perspectives—such as human rights, social justice, and empowerment—that are the foundations to successfully working with HIV-infected and HIV-affected persons and communities. Chapter 3 addresses a skill that should permeate all of the others: cultural competence. Chapter 4 suggests how HIV social work would be different in the United States if the human rights framework were applied more universally.
The second section focuses on social work practices and how they are used in the HIV field. Experienced practitioners and experts were asked to write what they would like other practitioners to know about their methods. Chapters 5 through 8 address case management, crisis intervention and counseling, social work in medical settings, and group work and family support. Chapters 9 through 12 address the practice methods of program development and management, community organizing and grassroots advocacy, political and legislative interventions, and HIV prevention.
The third section highlights some of those populations that have been particularly vulnerable to HIV. The retrovirus cannot differentiate between humans, but humans certainly can and have differentiated between each other, and those disparities have caused much despair. We acknowledge that there is overlap: An individual can be a member of several groups, and vulnerable groups have many experiences in common. Even though it is problematic to separate people in this way, it is done purely for educational purposes. Chapters 13 through 19 highlight the particular vulnerabilities of women, men who have sex with men, children and adolescents, midlife and older persons, people of African descent, and people of Latin descent. The final special population is HIV-affected caregivers.
Each of the aforementioned chapters includes vignettes by HIV-infected or HIV-AFFECTED persons who have written about their experiences in regard to the topic on which the chapter is focused. In this way, we include the voices of those who are living with the reality of HIV so that the reader is not hearing only from those of us in agencies or in academia.
Finally, the Afterword looks backward and forward, reflecting on the major lessons brought forward by the book’s contributors and calls attention to what practitioners might expect. Turning to face the future of the pandemic, what do we need to hope, what do we need to fear, what do we need to learn, and what do we need to do?
Several notes about the book’s scope are required. First, this book has an unabashed social work perspective. I am a social worker and invited only other social workers to be first authors of each chapter. Most of the coauthors are social workers as well. We made efforts not to drown the reader in professional jargon and to stay connected to HIV-INFECTED persons and their communities, but we must acknowledge that these chapters are written by authors with a particular philosophy, experience, and worldview. There has not been a handbook or textbook specifically for social workers in the HIV field for almost a decade, and given that the pandemic has changed dramatically during that time, the chapter authors were tasked with updating the practice wisdom in the social work field. Second, we chose to focus on HIV practice and policy in the United States. HIV is international, but this book strives to address the need for a handbook in the United States, and one book cannot cover the globe. Third, although we address many types of people who are hit hard by HIV, there are still many vulnerable populations to which we did not have the space to devote a chapter (such as sex workers, injectors, persons with chronic mental illness, and men and women in the criminal justice system).

ACKNOWLEDGMENTS

The HIV field is one of the few where the original services and advocacy responses were invented by those who were most affected and most vulnerable. We all owe a tremendous debt to persons with HIV who patiently showed us what they needed us to do as we stood in solidarity with them. Michael Shernoff, an HIV-infected New York social worker, published an editorial in Social Work in 1990 saying that AIDS would touch the professional lives of almost every social worker, that social work skills and values were well suited to HIV work, but that there was still much for us to do. I remember being both stunned and overjoyed as I read his comments (when I was a community-based advocate and case manager), because the main journal of my profession was finally acknowledging HIV. Michael died on June 17, 2008, of pancreatic cancer; although he was too ill to accept my repeated invitations to write a chapter or vignette, he knew that I was going to acknowledge our gratitude to him as one of the first to write about HIV and social work practice. He is one of countless pioneering HIV-infected teachers, supervisors, activists, service recipients, and mentors who taught us what we know. For this reason, many of the chapter authors have acknowledged a colleague or friend who is living with HIV or who died from AIDS.
I end with several personal notes. First, it was my honor and privilege to work with these distinguished longtime HIV advocates and practitioners who contributed chapters, to be the one to stitch together the quilt pieces woven by these accomplished colleagues. Obviously, the book would not have been possible without each and every one of them. They all wrote because of dedication and love, and they have my deep appreciation. Second, I could not have made it through the arduous editing and publishing process without the stellar John Wiley & Sons team: Peggy Alexander, Rachel Livsey, Kara Borbely, and Sweta Gupta. Third, it was never my idea to edit a social work and HIV anthology; that was always the brainchild and heart-child of Lisa Gebo, my colleague and friend, who urged me to do this for a decade before she accepted a job at John Wiley & Sons and convinced me to sign a contract after she went there. Although she could not work on this project due to being seriously ill, I felt her spirit shepherding me all the way. Fourth, I must acknowledge my own HIV mentor, Bill Edens Jr., who recruited me into the HIV field in 1987, convinced me that I was needed and could do the work, and generously and brilliantly taught me everything I know about HIV work: case management, crisis intervention, prevention, community organizing, professional education, volunteer training, group work, committee work, fund-raising, supervision, management, and legislative advocacy. He was a social worker in every way but name and training. He died of AIDS in 1993, and I still miss his humor and wisdom. Finally, I dedicate the book to my father, Ralph Alston Cannon, from whom I got my interests in scholarship, writing, teaching, and social justice. Although he did not live to see this book come into being, it is nonetheless an extension of his legacy.

REFERENCES

Piot, P. (2006). AIDS: From crisis management to sustained strategic response. Lancet, 368, 526-530.
Shernoff, M. (1990). Why every social worker should be challenged by AIDS. Social Work, 35(1), 5-8.

About the Editor
Cynthia Cannon Poindexter, MSW, PhD, is Associate Professor at the Fordham University Graduate School of Social Service in New York, where she teaches HIV practice, HIV policy, management, supervision, and human rights. Dr. Poindexter has been in the HIV field since 1987, when she began volunteering with the Palmetto AIDS Life Support Services (PALSS), the first AIDS Service Organization in South Carolina, as a crisis line volunteer, volunteer buddy, grant writer, and trainer. She went on to become the first social worker employed by that agency, becoming statewide Program Director and then Assistant Director. She has consulted with seven local and state HIV service programs in Boston and Chicago. She has been a trainer for the South Carolina AIDS Training Network, the Midwest AIDS Training and Education Center, the New England AIDS Education and Training Center, the NASW HIV Spectrum Project, the Massachusetts Department of Public Health HIV Division, and the HIV/AIDS Service Administration of New York City. She received a bachelor’s degree from Duke University, an MSW from the University of South Carolina, and a PhD from the Jane Addams College of Social Work at the University of Illinois at Chicago.

About the Contributors
Gary Bailey, MSW, is Associate Professor at Simmons College School of Social Work, Boston, Massachusetts. He received an MSW from Boston University School of Social Work in 1979. He received an Advocacy Award from the Multicultural AIDS Coalition in 1997, the Congressman Gerry Studd’s Visibility Award in 1996 from the Fenway Community Health Center in Boston, and the Bayard Rustin Spirit Award in 1999 from the AIDS Action Committee of Massachusetts. Bailey was named Social Worker of the Year by both the National and Massachusetts NASW in 1998. He has been in the HIV field for more than 20 years.
 
Alida Bouris, MSW, PhD is Assistant Professor at the University of Chicago School of Social Service Administration. She has 15 years of experience in the HIV prevention field. Her research interests are in family-based interventions to prevent sexually transmitted infections, HIV infection, and pregnancies among Latino adolescents and young adults. She received a BA in Women’s Studies from the University of California at Berkeley and MSW and PhD degrees from the Columbia University School of Social Work. She has published scholarly articles on parental influences on Latino adolescent risk behavior, including youth involvement in alcohol, tobacco, and sexual risk behaviors.
 
David J. Brennan, MSW, PhD, is Assistant Professor at the Factor-Inwentash Faculty of Social Work, University of Toronto. He has been in the HIV field since 1983 when he volunteered on the AIDS Action Hotline in Boston, Massachusetts. His research focuses on HIV among gay and bisexual men, particularly the effect of childhood sexual abuse, optimistic beliefs about treatment, and body image on risk. He received his bachelor’s degree, MSW, and PhD from Boston College. In 2006, Brennan was the recipient of the Boston College Graduate Student Research Excellence award for the work on his dissertation.
 
Douglas M. Brooks, MSW, is Vice President for Health Services at the Justice Resource Institute in Boston, Massachusetts. He began volunteering in HIV work in 1983 and began paid work in 1992 with the Provincetown AIDS Support Group. He consults with South Africa’s Eastern Cape Province Department of Health. He received an MSW from Boston University in 1999. He is a recipient of the Bayard Rustin Award and the Stonewall Award for his leadership in the LGBT community in Boston and of the Hubie Jones Award for Urban Social Work from the Boston University School of Social Work Alumni Association. He has recently been appointed to the Presidential Advisory Council on HIV/AIDS.
 
Valerie Dixson-Anderson, MSW, is a parent and child specialist with the Health Federation of Philadelphia’s Home Visitation Program. She is also a co-facilitator for an HIV support group for women for the past seven years. Her group work experience began in 1995 when she facilitated support groups with a variety of agencies throughout the Philadelphia area, working with adult women and teenage girls, providing educational support, parenting skills, and wellness services. Dixson-Anderson received an MSW from the University of Pittsburgh. She incorporates poetry as a therapeutic tool to foster personal growth, to allow for self-expression, and to promote healing.
 
Charles A. Emlet, MSW, PhD, is Associate Professor of Social Work at the University of Washington, Tacoma, and affiliate faculty member at the University of Washington Center for AIDS Research. He entered the HIV field in 1986 when he initiated an AIDS home care project and AIDS Medicaid waiver program in Solano County, California. Emlet received an MSW from California State University, Fresno, and a PhD from the Mandel School of Applied Social Sciences at Case Western Reserve University. In 2004 he received the University of Washington Tacoma’s Distinguished Research Award for his work on aging and HIV.
 
Nicholas Robertson Forge, MA, MSW, is a Professional Associate in the Social Work Department at Mercy College in Dobbs Ferry, New York. He received an MA in sociology from Florida Atlantic University, an MSW from Georgia State University, and is currently a PhD candidate at Fordham University Graduate School of Social Service. His MSW field placement was with persons with HIV at a large public hospital. His research interest is HIV stigma. He is on the steering committee of the New York City NASW LGBT Committee. He is a trainer for the New York City HIV/AIDS Services Administration.
 
Susan M. Gallego, MSSW, is Mental Health/Substance Abuse Rural Border and HIV Programs Coordinator with the Texas Department of State Health Services. She has been in the HIV field for more than 20 years, serving as Director of Client Services at the San Francisco AIDS Foundation and Director of Client Services for AIDS Services of Austin. She is a Certified Master Trainer for the National Institute of Drug Abuse and has served as cochair of the advisory board of NASW’s HIV/AIDS Social Work Training Project. Her master’s degree is from the University of Texas at Austin School of Social Work.
 
Larry M. Gant, MSW, MA, PhD, is Professor at University of Michigan School of Social Work. He has been in the HIV field for more than 20 years. His research concerns HIV-AFFECTED children, HIV risk among Latinos and African Americans, and HIV treatment. He has received research support from the Kellogg Foundation, Blue Cross/Blue Shield, Centers for Disease Control, Microsoft, and the National Institutes for Drug Abuse. He received a master’s degree in psychology, an MSW, and PhD in social work and social psychology from the University of Michigan. He served on the Advisory Committee of NASW’s HIV/AIDS Spectrum Training Project.
 
Brian Giddens, MSW, is Associate Director of Social Work and Care Coordination for the University of Washington Medical Center and Clinical Associate Professor with the University of Washington School of Social Work, where he teaches courses integrating organizational practice, leadership, ethics, and health care. Previously he was Director of Services for the Northwest AIDS Foundation in Seattle and on the Advisory Committee of the NASW HIV/AIDS Spectrum Project. He received an MSW from the University of Washington. In 2004 he was named a DHHS Primary Health Care Policy Fellow and NASW Social Worker of the Year by the Washington State Chapter.
 
Vincent Guilamo-Ramos, MSW, PhD, is Associate Professor at the Columbia University School of Social Work and a licensed clinical social worker. His research on HIV prevention is funded by the National Institutes of Health and the Centers for Disease Control and Prevention. He has been working in the HIV field for 20 years. He was a national trainer and Advisory Committee member for the NASW’s HIV/AIDS Spectrum Project. He received an MS in Nonprofit Management and Public Policy and an MSW from New York University and a PhD in Social Welfare from the State University of New York at Albany.
 
Bernadette R. Hadden, MSW, PhD, is Assistant Professor in the MSW program at the Hunter College School of Social Work, New York and in the PhD social welfare program at the Graduate Center of the City University of New York. She has been conducting research on HIV risk and prevention for the past 20 years. She received a BSW from the University of the Western Cape in South Africa, a master’s degree in philosophy from the Columbia University Graduate School of Arts and Sciences, and MSW and PhD degrees from the Columbia University School of Social Work.
 
Winston Husbands, PhD, is Director of Research and Program Development at the AIDS Committee of Toronto. He entered the HIV field in the early 1990s as a volunteer with the Black Coalition for AIDS Prevention in Toronto. He joined the AIDS Committee of Toronto in 2001. He has been cochair and Director of the African and Caribbean Council on HIV/AIDS in Ontario. His bachelor’s and master’s degrees are from the University of the West Indies (Kingston, Jamaica), and his doctorate is from the University of Western Ontario (Canada). He taught at the University of Zambia and Ryerson University in Toronto.
 
Hugo Kamya, MSW, PhD, is Professor at Simmons College of Social Work. For the past 20 years, he has worked in the HIV field and has been committed to serving HIV-AFFECTED children and families. A native of Uganda, he has for many years returned there to do research on child-headed and granny-headed families. Kamya received an MSW from Boston College, a Master of Divinity from Harvard University, and a doctorate in psychology from Boston University. In 2003, the American Family Therapy Academy recognized his work with an award for Distinguished Contribution to Social and Economic Justice.
 
Ryan M. Kull, MSW, provides psychotherapy services in private practice with an emphasis on working with gay men or those infected with HIV. He is also an Adjunct Instructor at Fordham University Graduate School of Social Service, provides training to caseworkers at New York City’s HIV and AIDS Services Administration, and is a full-time doctoral student at New York University Silver School of Social Work. He served as a codirector at Columbia University’s Gay Health Advocacy Project for six years and served as a prevention expert for The Body.com, a web site that provides information on HIV.
 
Helen Land, MSW, PhD, is Associate Professor at the School of Social Work at the University of Southern California, Los Angeles. She has been in the HIV field since 1986; she has volunteered in facilitating support groups for HIV caregivers and has educated volunteers and social workers about suicide prevention and depression associated with HIV. She has published two books on HIV and has written about coping in HIV caregivers. She received an MSW at Syracuse University and a PhD at the University of Pittsburgh School of Social Work. She has received the Hutto Patterson Award for excellence in teaching and research.
 
Michael Lewis, MSSW, PhD, is an Associate Professor at the Hunter College School of Social Work. He has degrees in psychology from Western Maryland College (BA), the Columbia University School of Social Work (MSSW), and the Graduate Center of the City University of New York (PhD in sociology). Lewis teaches courses in social policy and the economics of social policy, and his research interests are primarily in the areas of income distribution and quantitative methods. He is new to the HIV field.
 
Nathan L. Linsk, MA, PhD, is Professor at the Jane Addams College of Social Work at the University of Illinois at Chicago. In 1988 he established and continues to be Principal Investigator for the seven-state Midwest AIDS Training and Education Center. He is Co-Principal Investigator for the Great Lakes Addictions Technology Transfer Center. Linsk has shared leadership for establishing the first MSW and PhD social work education programs in Ethiopia. He was an African AIDS Regional Research Fulbright Fellow in Ethiopia in 2006. Linsk is founding coeditor of the Journal of HIV/AIDS and Social Services.
 
Vincent J. Lynch, MSW, PhD, is Director of Continuing Education, Boston College Graduate School of Social Work. In 1988, he founded the Annual National Conference on Social Work and HIV/AIDS, which he continues to chair. He has edited four books on Social Work and HIV/AIDS. His awards include the Council on Social Work Education’s “Distinguished Recent Contributions to Social Work Education Award” (1998), the Harlem Life Community AIDS Center’s “Harlem Life Award” (1998), and the Massachusetts National Association of Social Workers’ “Greatest Contribution to Social Work Education Award” (2001). Lynch has obtained more than $1 million in grants for social work AIDS education projects.
 
Dana B. Marlowe, MSW, PhD, is an Assistant Clinical Professor at the Fordham University Graduate School of Social Services in New York, where she teaches Generalist Practice, Social Justice, and Social Policy. She began working in the HIV field in 1989 as a volunteer buddy. She has worked for a Hospital Pediatric AIDS Program and a community-based AIDS Service Organization. She served on Ryan White Title I and II Steering Committees. She is a trainer for the New York City HIV/AIDS Services Administration. She received an MSW at the State University of New York at Buffalo School of Social Work.
 
Sally Mason, MSW, PhD, is Associate Professor of Clinical Social Work at the Institute for Juvenile Research, University of Illinois at Chicago, where she is Director of Social Work Training and researcher and clinician in the Division of Child and Adolescent Psychiatry. She began working with people with HIV in 1987 at the Howard Brown Memorial Clinic in Chicago. She established one of the first custody planning programs for HIV-positive parents in the United States. She received an MSW from Loyola University and a PhD at the Jane Addams College of Social Work at the University of Illinois at Chicago.
 
Michael P. Melendez, MSW, PhD, is Professor and Chair of the Clinical Practice Sequence at Simmons College School of Social Work in Boston, Massachusetts. He has been in the HIV field since 1983, volunteering for four AIDS Service Organizations in Boston. He received an MSW from Boston University and a doctorate from the Mandel School of Applied Social Sciences, Case Western Reserve University. He is the recipient of the 1998 Elizabeth Ramos AIDS Activist Award from the Latino Health Institute and the 2003 AIDS Action Spirit Award of the AIDS Action Committee in Boston.
 
Claudia Lucia Moreno, MSW, PhD, is Associate Professor at the Fordham University Graduate School of Social Service in New York, teaching HIV policy and practice. She received an MSW from Rutgers and a PhD from Ohio State University. She has consulted with several national HIV programs, funded by organizations such as the American Psychological Association and the Centers for Disease Control, to address HIV risk for Latinas. She was the Principle Investigator of a pilot study at the Columbia University Center for Intervention & Prevention Research on HIV and Drug Abuse on Cultural Adaptation of HIV interventions with high-risk couples.
 
Peter A. Newman, MSW, MA, PhD, is Associate Professor at the Faculty of Social Work, University of Toronto. He conducts HIV prevention research in Canada, India, South Africa, Thailand, and the United States. He entered the HIV field 25 years ago as a volunteer at the AIDS Action Committee in Boston. He received an MSW from Hunter College School of Social Work in New York and a PhD from the University of Michigan. He received the Early Researcher Award from the Ontario Ministry of Research and Innovation in 2007 for his cutting-edge work on the social dimensions of HIV vaccine development.
 
Tyrone M. Parchment, MSW, is the Black Male Initiative Program Coordinator at John Jay College of Criminal Justice, which intends to increase, encourage, and support the inclusion and educational success of underrepresented groups in higher education, particularly Black males. He is a Research Assistant for Darrell P. Wheeler, PhD, at Hunter College School of Social Work. Parchment is new to the HIV field. He is engaged in initiatives to encourage diversity and undo structural racism. He received a BA in sociology from Hunter College in 2006 and an MSW with honors from Hunter College School of Social Work in 2008.
 
Manoj Pardasani, MSW, PhD, is Associate Professor at the Fordham University Graduate School of Social Service in New York, where he teaches management and social work practice. From 2001 to 2004 he directed a residential program for dually diagnosed HIV-positive individuals. His HIV-related research, presentations, and writing concern prevention among sex workers in India and African American gay men in the United States, homelessness, and cultural competence. He received an MSW and a PhD from the Wurzweiler School of Social Work at Yeshiva University. In 2004 he was named Outstanding Researcher of the Year by the National Council on Aging.
 
Patricia A. Stewart, MSS, is a Site Director for Behavioral Health at the Family Practice and Counseling Network, an affiliate of Resources for Human Development in Philadelphia, Pennsylvania. She is also in private practice. She has been involved in work with people living with HIV since the early 1990s. Stewart received a Master of Social Service degree from Bryn Mawr College Graduate School of Social Work and Social Research. For her work in the field of HIV, she has twice received commendations from the National Association of Black Social Workers for outstanding contributions to the African American community.
 
Susan Taylor-Brown, MSW, PhD, is Clinical Professor of Pediatrics at the University of Rochester Medical School, incorporating HIV concerns into teaching and research. She has been working with HIV-affected families since 1986, when she became involved in efforts to address the needs of HIV-affected children. Throughout her academic career, she has drawn attention to the unmet needs of HIV-affected families. She received an MSW from Catholic University of America and MPH and PhD degrees from the University of Pittsburgh. She created and for 12 years directed the Family Unity Retreat, a four-day retreat for HIV-affected families.
 
Laurens G. Van Sluytman, MA, MSW, is a licensed therapist and Project Director of the Community Response Study, an NIH research study of crystal methamphetamine use and interventions among men who have sex with men (MSM) in New York City. He received an MA from New York University and an MSW from Columbia University and is a doctoral candidate at the Hunter College School of Social Work. His research focuses on identifying and exploring network risk and resiliency among Black men who have sex with men. He was the project coordinator of a CDC study investigating HIV risk behaviors among Black MSM in New York City.
 
Darrell P. Wheeler, MSW, MPH, PhD, is Associate Professor and Associate Dean for Research at Hunter College School of Social Work (HCSSW). For the past 20 years, Wheeler’s research and publication interests focus on identification and exploration of individual and communal resiliency in HIV prevention and intervention through strength-based approaches. Under his direction, HCSSW, in partnership with other U.S. and Nigerian organizations, has been selected by American International Health Alliance’s HIV/AIDS Twinning Center Program to assist in developing and strengthening the capacity of Nigerian institutional services provided to Nigerian children orphaned or made vulnerable by HIV.
 
Lori Wiener, MSW, PhD, is Coordinator of the Pediatric Psychosocial Support and Research Program at the National Cancer Institute. She has been working in the field of HIV since 1982. She entered the National Institutes of Health in 1986 to help the National Cancer Institute incorporate pediatric HIV disease into its pediatric oncology program. Wiener has published several unique therapeutic workbooks—including This is My World, for children living with life-threatening diseases, and Brothers and Sisters Together, for siblings. Wiener received master’s and PhD degrees in social work from New York University.

PART ONE
HIV BASICS AND SOCIAL WORK PRINCIPLES

Chapter One
HIV HISTORY, ILLNESS, TRANSMISSION, AND TREATMENT
Ryan M. Kull
INTRODUCTION
HIV disease—a condition caused by infection with the human immunodeficiency virus—is a complex, incurable illness that can lead to a life-threatening condition called Acquired Immune Deficiency Syndrome (AIDS). Since the first documented AIDS-related deaths in 1981, HIV disease has grown into a global epidemic—known as a pandemic—that profoundly affects individuals and their interpersonal relationships throughout the human life cycle. In addition to being a serious biological disease, HIV creates social, political, and economic problems that highlight international injustices. HIV disease brings global attention to homophobia, oppression of women, racism, poverty, and health care disparities.
Early in the pandemic, it was clear that people could reduce HIV transmission if they had access to the tools to do so, such as condoms, clean needles, and reproductive care. Advances in medication treatments have made HIV disease more manageable and much less deadly, but millions of people worldwide still do not have access to adequate medical care and treatment. A person with access to skilled HIV care in New York City might perceive and experience HIV disease quite differently than a working-class single mother in the rural southern United States. Epidemiological data illuminate how HIV disease disproportionately affects marginalized people throughout the world: Women, African Americans, Latinos, those in poverty, sex workers, injecting drug users, and men who have sex with men. While advances have been made in the medical treatment of HIV, social and political actions have fallen behind.
Health care and social service professionals can have a powerful impact on the effects of HIV. Basic knowledge about the science of HIV disease—how it is transmitted, prevented, and treated, as well as its sociopolitical history—is an important foundation for any human services practitioner. This chapter provides basic historical, epidemiological, biological, immunological, medical, and prevention information so that social service providers can be prepared to provide information and support to persons with HIV and those at risk for HIV infection. Some information found in this chapter is knowledge that will remain relatively stable over time (for example, information about biology, transmission, and history). Facts about treatment, prevention, and epidemiology change more frequently, and those working in HIV services should monitor these changes regularly.
Acknowledgments: I thank Laura Pinsky, Peter Staley, and Dr. Paul Bushkuhl for their expertise on the medical and prevention aspects of HIV and AIDS, and Michael Clemens for feedback on a draft of the chapter. I am also grateful to Chris for providing his perspective on living with HIV.

THE EMERGENCE OF HIV IN THE UNITED STATES

The First 20 Years

From June to August 1981, the Centers for Disease Control and Prevention (CDC) published three reports documenting two rare conditions—a form of cancer called Kaposi’s sarcoma (KS) and a pulmonary condition called Pneumocystis carinii pneumonia (PCP)—in previously healthy men living in New York and California (CDC, 1981a, 1981b, 1981c). Of the 108 documented cases, 95 percent were 25 to 49 years of age and 43 of the men had died. The mysterious link between these rare fatal illnesses and the subjects’ histories of same-gender sexual behavior confounded public health investigators. Because physicians treating these cases associated the illness with men who identified as gay, names like gay-related immunodeficiency disease (GRID) and gay cancer were assigned to the condition. The CDC—a branch of the government public health service that monitors and intervenes in existing and emerging diseases—sent researchers to investigate the possible causes of this emerging public health crisis. Through months of extensive interviews, medical examinations, and analyses of social networks, researchers speculated that the mysterious illness was likely caused by an infectious microorganism transmitted between people through sexual contact.
Gay men were not the only population being affected by this newly discovered disease. In the first half of 1982, the CDC had documented cases among people with hemophilia, injection drug users, heterosexuals, babies, and Haitians. Because the disease was no longer considered to be limited to gay men, and because it was transmitted not only through sex but also blood contact, the CDC identified the illness more broadly as acquired immune deficiency syndrome, or AIDS (Harris et al., 1983).
In 1983, a French virologist Dr. Luc Montagnier and his research team at the Pasteur Institute isolated HIV, the virus that causes AIDS. By mid-1985 this pivotal discovery led to the development of an antibody test which could detect HIV in the blood supply and human infection well before an AIDS diagnosis. The HIV antibody test remains the gold standard for diagnosing HIV infection to this day.
In the absence of a clear scientific understanding of AIDS, the disease readily became a metaphor for the “immoral” behavior of gay men and drug users. The pandemic’s emergence during Ronald Reagan’s presidency, backed by social and religious conservatives, resulted in a lack of federal governmental attention to the public health emergency. President Reagan did not make any reference in his speeches to AIDS until 1987, six years after the first reports of a fatal infectious disease. That same year, Republican senator Jesse Helms introduced a bill that refused federal funding to groups that “promote” homosexuality in their education and literature, creating a significant barrier to public funding of gay-related AIDS organizations (Levine, Nardi, & Gagnon, 1997).
Gay communities in New York City and San Francisco, responding to political and social inaction, organized grassroots political action and community advocacy groups such as AIDS Coalition to Unleash Power (ACT UP), Gay Men’s Health Crisis (GMHC), and AIDS Project Los Angeles (APLA). ACT UP’s primary mission was to bring attention to the absence of a public health response to the AIDS crisis; the slogan “Silence = Death” (see Figure 1.1