health

Because there is no known cure or vaccine for HIV infection, prevention

and control strategies are extremely important. The early dramatic rise in

HIV in the United States was reversed by the late 1980s due to prevention

campaigns that increased condom use among gay men. However, during

the last decade the rate of new infections has remained stable instead of

continuing to decrease. In 1998, an estimated 75,000 persons became

infected in the United States. Hence, prevention challenges are greater

than before. The main approaches are as follows:

1. Promotion of safer sexual behaviors. Since the onset of the pandemic,

information, education, and communication campaigns have been vital in

reducing behaviors that put individuals at high risk for infection. These

campaigns are of two types: broad mass communication for the general

public, and targeted, more intensive behavioral change communication

strategies aimed at vulnerable groups. Person-to-person education

programs are important for certain vulnerable groups because such

programs increase the level of knowledge about AIDS and high-risk

behaviors.

2. Promotion of condom use. The promotion of safer sexual behaviors,

including the use of condoms, is an integral part of prevention and

control strategies.

Condom use is encouraged through programs that involve market

research, product importation, brand name packaging, advertising,

media promotion,

distribution, and management.

3. Prevention and treatment of STDs. Conventional STDs facilitate

the transmission of HIV. Because of its adverse effect on the immune

system,

HIV infection can alter the incidence, natural history, and response to

treatment of other STDs. In addition, these diseases rank among the

top ten most important health problems in nonindustrialized countries

in terms of years of healthy life lost (Over and Piot, personal

communication, 1990).

The early diagnosis and treatment of sexually transmitted diseases

combined with behavioral intervention is recommended.

4. Prevention of unsafe drug use behavior. Prevention strategies for

injected drug users in drug abuse treatment programs are successful

but expensive.

Community-based outreach programs that include education regarding

the need to eliminate needle sharing, instruction in the disinfection of

contaminated injection equipment, bleach distribution, and needle

exchange are less expensive and equally successful. Each interaction

with a client provides an opportunity for risk reduction education.

5. Provision of a safe blood supply. Transfusion-induced HIV infection

can be prevented by safe blood initiatives, including rational use of blood.

Yet as many as 3% to 5% of HIV-infected individuals in sub-Saharan

Africa and parts of Asia become infected by contaminated blood. This is

attributed to the low effectiveness of safe-blood programs in these countries.

6. Targeted interventions. For individuals at high risk of HIV infection, an

epidemiologically sound set of preventive activities (interventions) are

put together as a package. These interventions not only are easy to implement

but they are cost-efficient and their impact is measurable.