From the author: The article examines the role and tasks of psychologists in preventing the spread of HIV infection. Not only those psychologists who work in the fight against AIDS. These are already working. We are talking about practicing psychologists. “What do you think about HIV/AIDS?” “What do you think about your role in HIV/AIDS prevention, colleague?” In the video, Kirill Sharkov and Alla Vadimovna Shaboltas talk about an important social problem and the tasks arising from it - the prevention of HIV infection, where psychologists and psychotherapists can be useful. Alla Vadimovna Shaboltas is the dean of the faculty of psychology, head of the department of behavioral psychology and the prevention of behavioral anomalies of St. St. Petersburg State University (SPbSU), associate professor, candidate of psychological sciences, chairman of the Ethical Commission of the Russian Psychological Society (RPS). Kirill Sharkov is a psychotherapist, host of the media magazine “Psychotherapy in Russia.” Psychotherapy in Russia is a media magazine about modern Russian and world psychotherapy, psychotherapists and trends in practical psychology. How to eliminate myths? How to overcome taboos and stigmatization? And start discussing openly the difficult and not very pleasant... In fact, these topics highlighted by the interlocutors are the main tasks at the present stage in the work of psychologists in the direction of preventing HIV infection and the development of AIDS, preventing and combating stigma and discrimination. The main goal this specific activity is a change in attitude towards the disease itself and towards prevention. To my taste, this composition is just right as a musical accompaniment to the topic - Prevention was once carried out extremely aggressively and rudely - by the method of intimidation, causing disgust towards people at risk, reducing their contacts to no... The result of that early campaign was AIDSphobia, stigmatization and discrimination of people living with HIV, people at risk going underground and loss of direct contact with them, the spread of HIV/AIDS beyond risk groups, and the activation of HIV deniers. The latter is especially worth mentioning, since their influence among people living with HIV caused refusals of the proposed therapy, which aggravated their condition, up to the loss of life, refusal to prevent the transmission of HIV to children during pregnancy, childbirth, and breastfeeding, which led to the infection of children. Well, what else could you expect in a country in which there is no constructive conversation about the culture of sex?! Its citizens easily confuse pornography, erotica and prevention, and therefore prefer to simply make the topic taboo, so as not to let slip about their ignorance on issues of intimate relationships... The sexual revolution did not pass without a trace. TV shows, talk shows one after another... Yes, what can I tell you - see for yourself - Well, now in Russia over a million people live with HIV - According to the Federal AIDS Center, in 2016 the number of people infected with HIV in Russia reached 1 million people According to the government, since 2006 in Russia there has been an annual increase in the number of new cases of HIV infection by an average of 10% annually. The leaders (about 2%) are Irkutsk, Samara, Sverdlovsk, Leningrad, Kemerovo regions, Crimea (link to the map of the prevalence of HIV infection in Russia at the end of the article) Subsequently, approaches to prevention were revised, but not as widely as we would like, even and among specialists involved in the prevention of HIV/AIDS. One can positively evaluate the experience of the WHO and the Joint United Nations Program on HIV/AIDS (UNAIDS), the Global Fund to Fight Viral Diseases AIDS, the International Red Cross Organization, the international organization ICASO, non-governmental the organization Doctors Without Borders, efforts to combat HIV/AIDS around the world are also being made by other organizations at the international and national level, including the Russian system of medical centers for the prevention and control of AIDS, headed by the federal center. Currently, a developed WHO strategy to combat the virus epidemicimmunodeficiency. The strategy to counteract the infection was approved on October 20, 2016. Until this moment, Russia had not had such a large-scale document to address the problem of the spread of HIV. The strategy is of a framework nature, noted the director of the Federal AIDS Center, Vadim Pokrovsky, immediately after its adoption. It describes the necessary measures superficially and does not contain information on their financing. The Ministry of Health has developed a plan for the implementation of the state strategy to combat the human immunodeficiency virus (HIV) in Russia. The project is designed until 2020. The draft plan does not contain information about financing the strategy, but it lists in detail the points for its gradual implementation. For each of them, a deadline and a responsible executor are indicated. By the end of March 2017, the Ministry of Health intended to conclude an agreement with the World Health Organization (WHO) to create a special working group on HIV/AIDS in Russia. The approved concept involves the preparation of special programs to inform the population, work with especially vulnerable groups of citizens and the creation of a register of infected patients. The Ministry of Health also plans to introduce modern methods of prevention, diagnosis and treatment of HIV, develop appropriate clinical recommendations, train doctors in this area, work on the issue of priority registration of drugs against infection and improve epidemiological control.K In 2020, the department will organize “quick access centers” where it will be possible to do a rapid HIV test and get advice. (More details on RBC - link at the end of the article) What about psychologists, you ask. And indeed, identification and therapy are the work of doctors. But what about complete and accurate information, competent delivery of information, debunking myths about HIV/AIDS, sex education, developing a healthy attitude towards the disease itself and towards the prevention of HIV infection, and the fight against AIDS, the formation and development of health-saving skills, a kind attitude towards people living with HIV - in these areas the work of psychologists is irreplaceable. Doctors will not solve these problems. Moreover, taking into account the age and gender, psychosexual and personal development of the audience. Yes, they are not in front of them. Therefore, I agree with the opinion of Alla Vadimovna Shaboltas that work of this kind is important and necessary, and it is the work of psychologists to carry it out. Prevention is carried out now, but not systematically, progressively and purposefully, mainly through mass events. And the effect is many times higher when they are carried out by a competent specialist either in a small audience or face to face with an interested person. And it is psychologists who have the means for this work and the conditions. Among the most effective means, Alla Vadimovna named a motivational interview, in which a specialist briefly ascertains a person’s understanding of individual risks and the availability of strategies for managing them, assesses their effectiveness, if necessary, carries out corrections aimed at reducing risky behavior, taking responsibility for one’s activity (passivity), promotes the development of health-saving behavior skills, if necessary, helps debunk myths, relieves the tension of AIDSphobia and helps to normalize attitudes towards people living with HIV. Private practitioners may object - what about ethics - what kind of work is this beyond the request?! In modern conditions of the prevalence of HIV/AIDS in Russia, knowing about this, and I would call not asking a person who came to an appointment (even if he himself didn’t think about it) a crime against a person, his client - of course, not everyone, and not all of a sudden, but how to start a conversation and develop the client’s personal interest, every competent specialist should know. This is proactive care - prevention. And prevention is one of the types of work of a practicing psychologist. Of course, this is not the imputation of certain job responsibilities to colleagues (and even those who are not accountable to anyone), but as a call to civic position andprofessional responsibility, yes. The risk of unknowingly ending up among HIV-infected people is too great. Who would wish this on their clients?! When you come across cases of people becoming infected through ignorance, carelessness, oversight, or excessive naivety, you feel uneasy... It is clear that nowadays HIV infection is also being treated - there are modern drugs that support the functioning of the immune system. But the disease remains incurable. And this, of course, is scary, to suddenly lose your own immune shield at one moment, and forever. And become dependent on certain drugs... For now, but that’s how it is. People living with HIV are forced to take maintenance medications for life, without any breaks or omissions. What kind of life this is, people who take insulin know. That's why I ask. And I suggest a test, since I work at the AIDS center. And outside of work at the center, I ask: “What do you think about HIV/AIDS?” And since we are asking, who exactly should we ask, and who is not necessary? In fact, the slogan “HIV/AIDS affects everyone” was not just invented. Therefore, a general question, at least one, may well be asked of everyone. Another thing is with whom it is worth developing the topic, even in a situation where the person answers that he doesn’t want to talk about it, he didn’t come for that... Alla Vadimovna rightly believes that today there are no risk groups, as they were identified before, before 2000 years (drug users, gays, commercial sex workers and their clients, people who often change sexual partners). Now, all people can be defined as vulnerable if they do not have reliable information or are subject to myths, experience AIDS phobia, do not comply with safety measures not only due to illiteracy, but due to personal characteristics (for example, shy, timid, anxious, unsure in yourself...) or broken relationships with a partner. In addition, a good remedy is prevention in target audiences through group trainings - this work can be implemented by public organizations on a volunteer basis with the involvement of specialists. And, of course, Alla Vadimovna did not ignore the public level – public work. Personally, I am quite skeptical about this tool as a means of forming public opinion and attitudes, but as a way of attracting attention, I agree that this is an important matter. For the request #Stop_HIV_AIDS, the Yandex search engine returned 46 million results. And this is just for a specific request related to the All-Russian campaign, launched in 2016. The Internet is full of information. Many specialized information sites and resources for direct contact with specialists and people living with HIV. But there are no less communities of HIV deniers who actively conduct their propaganda. And with all this, there are people who have never heard about HIV/AIDS or have heard so much that it is very surprising. I myself came to work at the Center for the Prevention and Control of AIDS in Tuapse in 2009, and since 2000, prevention has been carried out on a different basis. Namely, “HIV is not scary when you know everything about it” and “HIV/AIDS affects everyone” – these slogans reflected a radical change in policy from intimidation to a policy of explanation and appeal to all people. It should be noted that the year 2000 was a turning point in the emergence of modern ART drugs in widespread use, which allowed WHO to transfer the disease HIV infection itself from fatal to fatal chronic. And this is a huge achievement. Explaining is much more difficult, and takes longer, and it needs to be done constantly, in any case, until a certain critical mass of awareness in society is achieved, public opinion changes, understanding of the essence of the disease and its prevention by each person and, especially, people having the power to make decisions and implement them. And yet, this method of prevention is the main one. Intimidation, fortunately, is a thing of the past. Now all people are partners in the fight against HIV/AIDS, preserving the health of humanity. Everyone fights in their place - doctors - in theirs, providing therapyspecific patients...;scientists - on their own, conducting research on drugs for therapy at the modern level; psychologists - on their own, carrying out the prevention of HIV infection and helping patients emotionally cope with the hardships of the disease, in adherence to treatment; employers - on their own, ensuring compliance with labor safety standards and access of workers to accurate and complete information about HIV/AIDS, the possibility of undergoing voluntary confidential counseling and testing for HIV at work, as recommended by the ILO, in collaboration with centers for the prevention and control of AIDS; all people, and the first among them activists from among people living with HIV and volunteers to the extent of their understanding of the problem and its resolution, pursuing responsible behavior... Particular attention in the implementation of the strategy to combat HIV/AIDS is paid to preventive measures. They concern not only people at risk, but also health workers who must properly perform their duties, but also all groups of the population that engage in behaviors associated with the risk of infection are considered vulnerable. Mostly these are young and middle-aged people, who make the main difference in the economy and in the birth rate, reproduction of the country's labor force; there are many of them, which is why the disease has received the status of socially significant. The fight against AIDS, according to WHO, should be carried out in all areas . This also applies to minimizing the risks of vertical transmission of infection. Women living with HIV are recommended to take three-step prophylaxis - during the perinatal period, during childbirth and while breastfeeding the baby. It is worth striving to ensure that young people, when deciding to expand their family, contact specialized medical institutions in advance to undergo the necessary research. This reduces the risk to 1-3%. With early treatment and cooperation between women-mothers and doctors, the best results can be achieved - most children are born and live without HIV. WHO also pays great attention to supporting people with HIV+. The main focus is on ensuring that people receive timely therapy with modern means. And they responsibly took therapy strictly according to the recommended regimen. The cost of skipping medications is too high. For this purpose, specific work is carried out on adherence to therapy, aimed at explaining and increasing the responsibility of patients. Along with this, as part of the fight against HIV infection, it is recommended to conduct preventive conversations among all segments of the population. And this work must be carried out skillfully and on time - at each age stage of development, starting with secondary school students, to the extent of understanding and emerging risks. This is necessary both to prevent infection - in terms of developing risk management and demythologization strategies, and preventing AIDS phobia. Likewise, to reduce stigma and discrimination in society - so that people living with HIV can live normally in modern society, are not afraid to ask for help, take advantage of their rights, get a job, turn to specialists, communicate freely, start families and gave birth to children. On the initiative of the International Labor Organization, together with the Ministry of Health and the Ministry of Labor and Social Protection of Russia in Sochi, as part of the All-Russian Occupational Safety Week, in the spring of 2016 and 2017, employees of the centers for the prevention and control of AIDS (Tuapse, Sochi, others cities of Russia) presented the technology of organizing and conducting voluntary and anonymous counseling and testing for HIV infection, with the aim of introducing the same preventive campaigns in the workforce of organizations and institutions together with AIDS centers. Safety must be ensured by people on an ongoing basis. Since 2016, a large-scale All-Russian campaign has started and is being held for the second year in May, timed to coincide with the International Day of Remembrance of People Who Died of AIDS #Stop_HIV_AIDS Every year on December 1 - International AIDS Day,57/ )