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An Objective Strategy for Medicine, Public Health, Business, and the Community

Donald P. Francis, MD, DSc; James Chin, MD, MPH

JAMA. 1987;257(10):1357-1366.

Abstract
Human immunodeficiency virus (HIV) is one of the most virulent infectious agents ever encountered. This virus, estimated to kill up to a half of those infected, has spread to more than 1 million Americans. There is no safe and effective treatment. Nor is there a vaccine. From our understanding of HIV transmission, further spread of the virus can be stopped by the use of various techniques. The combined use of education-motivation-skill building, serologic screening, and contact tracing/notification could eliminate or substantially reduce transmission. To accomplish this reduction an immense concerted effort by physicians, public health practitioners, business, and community organizations is required to get across the simple prevention messages. Those messages are: (1) Any sexual intercourse (outside of mutually monogamous or HIV antibody-negative relationships) must be protected with a condom. (2) Do not share unsterile needles or syringes. (3) All women who may have been exposed should seek HIV-antibody testing before becoming pregnant and, if positive, avoid pregnancy. Only through a concerted, vigorous, and sustained prevention program that deals frankly with this problem will those individuals at risk be reached and motivated to take personal responsibility to protect themselves. Without such an effort, acquired immunodeficiency syndrome will continue to kill ever-increasing numbers of Americans.

(JAMA 1987;257:1357-1366)

Author Affiliations
From the Centers for Disease Control, Atlanta (Dr Francis); Infectious Disease Branch, California Department of Health Services, Berkeley (Drs Francis and Chin); and Department of Epidemiology, University of California School of Public Health, Berkeley (Dr Chin).

Footnotes
The opinions expressed in this manuscript are those of the authors and not necessarily those of the Centers for Disease Control or the California Department of Health Services.

Reprint requests to Infectious Disease Branch, California Department of Health Services, 2151 Berkeley Way, Berkeley, CA 94704 (Dr Francis).

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