Revised HIV Prevention Strategy: New Hope or Smoke Screen?

Abstract

Since HIV was identified as the causative agent of AIDS, prevention has been the cornerstone of our response to the epidemic. In the early years of the epidemic, medical science had little to offer in the way of a cure or effective treatment to persons with HIV/ AIDS. Even now, with the availability of an arsenal of drugs that for many individuals are effective in slowing the progression of HIV, there remains no cure and available drug therapies have severe side effects. Very few individuals would argue that preventing HIV infection remains our best option in the war against HIV/AIDS. We have spent almost 2 decades working to make the public aware of HIV and to give individuals the knowledge necessary to protect themselves against infection. Information concerning high-risk behaviors associated with HIV infection has been the focus of media campaigns, community outreach programs, and population-specific prevention interventions. There has been an understanding that protecting yourself from HIV is a personal responsibility, and education is an important tool in formulating a personal response to avoid HIV infection. To a lesser degree, programs supporting HIVinfected individuals in dealing with the HIV infection (including behavioral changes to prevent further transmission) have existed in many communities. Once HIV testing became available, learning one’s HIV status was touted as essential in obtaining appropriate health care and preventing HIV transmission. It is frequently proposed that those who know they are HIVinfected will take the necessary precautions to prevent transmitting HIV. Although in many cases this has been true, experience has shown this is not a universal given. Despite all our prevention efforts, there continues to be an estimated 40,000 new cases in the United States each year. No doubt, transmission is taking place by the large number of individuals who do not know they are HIV-infected, as well as by some of those who do know they are infected. Clearly, there remains a vast need for HIV prevention efforts that focus on HIV-infected and noninfected individuals. Noting the continued high number of new HIV infections each year, the Centers for Disease Control and Prevention (CDC) announced this past spring that it is refocusing its prevention efforts to target HIVinfected individuals. Identification and intense counseling of those who are HIV-infected and their partners will take on new emphasis. This new strategy provided the underpinning for the four themes of the CDC’s 2003 National HIV Prevention Conference held in July. The conference themes focused on gaps in prevention with HIV-positive persons, progress and challenges of mother-to-child transmission, prevention needs of minorities and youth, and the role of the Internet in HIV risk and prevention. As part of the CDC’s strategy, a new HIV tracking system using the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS) will be implemented in 35 locations nationwide. The goal is to determine where new infections (in the past 6 months) are occurring so interventions can be targeted to those areas. Certainly, being able to follow the epidemic’s progression more accurately so that prevention programs can be targeted