Target Groups for Preventing AIDS Among Intravenous Drug Users

The acquired immune deficiency syndrome (AIDS) has rapidly become the most serious medical consequence of injecting illicit drugs. Its potential impact on intravenous (IV) drug use is enormous. Human immunodeficiency virus (HIV, also known as HTLV-III and LAV), the virus that causes AIDS, appears, usually, to lead to lifelong infection. At present there is no effective treatment, and the treatments under development may require lifelong antiviral therapy. Since most of the antibody produced in response to HIV infection does not neutralize the virus, and since there is substantial genetic variation in the virus, it will be difficult to develop a vaccine. Even after vaccines are developed, testing their safety and efficacy will be formidable problems. Until either effective treatment or vaccines are developed, control of the epidemic among IV drug users must be attempted through behavior change/prevention efforts. In this paper we will review the epidemiology of AIDS among IV drug users and characteristics of the IV drug-use subculture relevant to prevention efforts. We will then identify different target groups for these prevention efforts, present available evidence about behavior change in these groups, and then briefly discuss how to prevent transmission of HIV to heterosexual partners who are not themselves IV drug users and to the children of IV drug users.     

The relationship of affiliative arousal to dopamine release

Higher levels of affiliation motivation after exposure to affiliative films are significantly related to higher dopamine concentrations in saliva in one study of 61 college students of both sexes, and in plasma in another study of 47 adults of both sexes. Individuals high in dispositionaln Affiliation, if they also reported high life stress, showed high gains in dopamine concentration in plasma after exposure to an affiliative film significantly more often than other individuals. Since aroused affiliation motivation was not associated with higher concentrations of norepinephrine, epinephrine, or cortisol in either study, it appears likely that dopamine is especially associated with arousal of affiliation motivation, just as norepinephrine has been found to be associated with arousal of power motivation. Thus, different motives may be subserved by different hormones, making it unlikely that all motives lead to the same state of physiological arousal.This research was carried out when all the authors were connected with the Department of Psychology and Social Relations at Harvard University. We acknowledge with thanks the support of the John D. and Catherine T. MacArthur Foundation through a grant to the senior author.     

Ethnotherapeutic empathy (EthE)—Part I: Definition,theory, and process

This paper introduces the concept of ethnotherapeutic empathyin working with ethnoculturally different patients to increase the efficacy of therapy. This form of empathy is used instrumentally to get to know the patient's inner problematic images, anxieties, fears, depressive affect, suffering, hurt, disillusionment, rage, joy, and triumph. Clinical empathy with ethnic patients is instrumental in that it is purposive:it sets out to achieve what might be called patient-comprehending(that is, finding out the nature of the patient's problems) using this as guide to intervening—a form of creativity-in-action. Ethnotherapeutic empathy utilizes active ego processes, in contrast to the passive processes implied in artistic appreciation and surrender. This article presents the definitions of empathy, and associated intrapsychic and social factors, as well as physiological responses in empathie responding. The implications for clinical practice with patients of differing ethnocultural and racial groups are discussed. The article develops a foundation for understanding the therapeutic matrix of applied ethnotherapeutic empathy which is detailed in the second part of this article (Ethnotherapeutic Empathy [EthE]—Part II: Techniques of Vicarious experiencing Across Cultures).     

Book reviews

The Popularization of Medicine 1650–1850 Roy Porter (ed.), 1992 London, Routledge pp. x + 296, £50 (hardback) ISBN 0415 07217 4

Quantum Mechanics: An Empiricist View Bas Van Fraassen, 1991 Clarendon Press, Oxford pp. 558, £17.50 (paperback), ISBN 019 8239807