possible to more fully evaluate the mechanisms which might link alteration in risk perceptions to subsequent behavioral or psychological effects. Certainly there is an urgent need for both observational and intervention studies in other populations. Special emphasis should be given to research with younger, minority, and less-educated participants which these findings identify as less likely to establish and maintain long-term, low-risk behaviors.
In spite of such cautions, these results suggest that an uncritical enthusiasm for testing or other techniques designed to create a sense of vulnerability to AIDS might be inappropriate. Those formulating policy to routinize or mandate testing need to consider carefully the full array of available information. There is no evidence in this cohort of beneficial effects from a sense of risk, while some deleterious effects on both mental health and behavior were observed. We suggest that global perceptions of increased risk might easily be transformed into a sense of hopelessness and helplessness in dealing with the AIDS epidemic or personal behavior. At a minimum, it seems evident that behavioral risk reduction is complex, related to multiple social and psychological phenomena, and unlikely to be the straightforward result of a single event or attitude.
This work was supported by funding from the National Institute of Mental Health (2 R01 MH39346-02A1) and the University of Michigan for the Coping and Change Study, and by the National Institute of Allergy and Infectious Diseases for the Chicago Multicenter AIDS Cohort Study N01-AI32535, with partial funding by the National Cancer Institute.
Special appreciation is expressed to participants in these concurrent studies whose continuing assistance makes this research possible. Please refer questions and comments to Jill G. Joseph, Ph.D., Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109.
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