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that is valid for any nonsingular square matrixes A, C, and (C 1 D A 1B). If we denote A 1 a Sold ; B d T ; C a; D d; d yk y* old
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tion with other STDs). Although physicians are likely to spend considerable time discussing the importance of consistent medication adherence, care providers should arguably direct equal attention to encouraging patients to avoid highrisk sexual and drug use practices. Likewise, behavioral scientists must devote increasing attention to the development and dissemination of empirically validated risk reduction interventions for HIV-infected persons. Multicomponent interventions that meld psychosocial support, adherence, and sexual risk reduction within HIV care settings may be a particularly promising direction for future research. FUTURE DIRECTIONS The past decade has seen tremendous activity for health psychologists who have conducted basic qualitative and correlational research; developed and re ned theoretical models of risk behavior; and implemented and evaluated individual, small group, and community-level interventions. In this chapter, we focused our attention on applied research, specifically on research evaluating behavioral interventions for the primary and secondary prevention of HIV disease. The intervention research has evaluated the effectiveness of a variety of theory-based interventions with a wide range of populations, including hard-to-access groups such as homeless adults, runaway youth, IDUs, and the severely mentally ill. Many large RCTs have been completed, and allow for strong inferences as they control for many threats to the internal validity of intervention studies. These RCTs have included multisite and international projects, which enhance the external validity of the ndings. Methodologically, the eld of psychosocial HIV/AIDS has advanced very quickly. Moreover, the research that has been completed has included unprecedented collaboration among patients, community-based advocates, and biomedical and social scientists. Continuing Challenges and Future Directions We expect that the impressive behavioral science commitment to HIV/AIDS that we have witnessed in the past decade will continue as health psychologists address a series of continuing challenges in research and practice. In this concluding section, we identify and discuss brie y the continuing challenges and future directions for research and practice related to HIV disease. Integration of Biopsychosocial Approaches We expect continued research to develop safe and effective vaccines and microbicides to prevent infection. This research
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is rarely in age dif ferences alone; often, the more compelling issue is in age changes (Miller, 1998). The trick, then, is to discover what changes and how changes occur in thoughts, emotions, and behavior over the life course. COGNITIVE CHANGES IN THE SELF OVER THE LIFE SPAN Schindler and Staudinger (2005, p. 7) define the combination of self and personality as all that we know about our behavior, past experiences, anticipated and idealized futures, needs and wishes, abilities, or weaknesses. The classical trait perspective argues that personality traits are biologically based, and as such do not change over time (McCrae et al., 2000). However, a life span approach acknowledges and attempts to explain intraindividual change and interindividual differences in intraindividual change (Baltes & Nesselroade, 1979). In a recent metaanalysis, Caspi, Roberts, and Shiner (2005) supported the rank-order stability in personality traits, with the level of stability in childhood and adolescence even higher than originally expected, but some change occurring throughout adulthood, although only modestly after age 50. This is 20 years later than the age at which McCrae and Costa (1997) claimed traits to be fixed. In the same meta-analysis, Caspi et al. found some changes in mean level of personality traits, particularly when metatraits such as extraversion were divided into their constituent elements of dominance and sociability. Even the old and very old (ages 70 to 103)
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