The fact that many HIV-infected adults desire and expect to have children has important implications for the prevention of vertical and heterosexual transmission of HIV, the need for counseling to facilitate informed decision-making about childbearing and childrearing, and the future demand for social services for children born to infected parents.

Diet, exercise, smoking, and substance use patterns affect the course of illness and quality of life for people with HIV. In interviews with a national probability sample of 2,864 persons receiving HIV care, it was found that most had made health-promoting changes in one or more of these behaviors since diagnosis. Many reported increased physical activity (43%) and improved diet (59%). Forty-nine percent of cigarette smokers quit or cut down; 80% of substance users did so. Desire for involvement in one's HIV care and information seeking-positive coping were the most consistent correlates of change. Other correlates varied by health practice but included health status, emotional well-being, demographics, and attitudes toward other aspects of HIV care. Most people with HIV improve their health behavior following diagnosis, but more might be helped to do so by targeting these behaviors in future interventions.

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Substance use research in the United States has focused on ethnicity/race to the detriment of studying the role of nonethnic sociocultural factors. Reliance on politically defined ethnic categories has not added to knowledge on the etiology, prevalence, prevention, or treatment of substance use and misuse. Rather it has reflected the preoccupation with race/ethnicity in the larger United States society and has contributed to further stereotyping of non-European ethnic groups. Ethnicity serves as a proxy for a number of sociocultural factors (e.g., socioeconomic status) that are linked to substance use. To make progress in understanding substance use and misuse, researchers must move away from the simplistic reliance on ethnic labels to a more complex understanding of the impact of the sociocultural variables that such labels represent.

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