Prevention of HIV infection. Looking back, looking ahead
J. Stryker, T. J. Coates, P. DeCarlo, K. Haynes-Sanstad, M. Shriver and H. J. Makadon
Department of Medicine, University of California, San Francisco 94105, USA.
For some, the occurrence of as many as 40,000 new human immunodeficiency
virus (HIV) infections in the United States each year is evidence that HIV
education and prevention efforts have failed. To the contrary, more than a
decade of experience with HIV has demonstrated that lasting changes in
behavior needed to avoid infection can occur as a result of carefully
tailored, targeted, credible, and persistent HIV risk-reduction efforts.
Given experience in other health behavior change endeavors, no
interventions are likely to reduce the incidence of HIV infection to zero;
indeed, insisting on too high a standard for HIV risk-reduction programs
may actually undermine their effectiveness. A number of social, cultural,
and attitudinal barriers continue to thwart the implementation of promising
HIV risk-reduction programs. The remote prospects for a successful
prophylactic vaccine for HIV and the difficulty in finding effective drug
treatments have underscored the importance of sustained attention to HIV
prevention and education. A series of "correlates of immunity" are
identified--precedents that must exist to establish effective HIV
prevention programs. These include sound policies promoting HIV risk
reduction; access to health and social services, condoms, needles, and
syringes; interventions shown to motivate behavioral change; organizations
capable of reaching those at risk; and development and diffusion of
technologies to interrupt the spread of the virus.
