AIDS prevention: issues and strategies

Abstract

Prospects for vaccines to prevent HIV infection and disease have dimmed appreciably in the past year, and drugs for chemoprophylaxis and/or chemical cure are both unlikely and grossly unrealistic as a means of global HIV control. However, the paucity of transmission routes and their susceptibility to strategies of blood screening and of education for behavior modification point in a clear direction for concerted effort. Where they have been applied, blood screening programs have resulted in a dramatic reduction in transfusion-associated infections, and efforts at enhancing donor- and unit-deferral strategies offer promise of further decrease in risk. There is much encouragement in recent reports of education for prevention. While there has been some unevenness in the extent to which successful risk reeducation has occurred, it is nonetheless dramatic compared with prior health educational efforts, and especially so given the exceptional sensitivity of the sexual and illicit drug using behaviors at issue. Finally, clearly articulated public education and particularly correction of misinformation, can contribute significantly to overall prevention efforts by easing fear and enhancing the climate in which persons at behavioral risk of HIV infection can receive and respond to targeted messages.

PIP: Modes of preventing the spread of AIDS that have been successful are reviewed. Marked reduction in rates of seroconversion have been recorded among homosexuals in San Francisco and Stockholm, despite high seroprevalence of HIV, due to cohesiveness of the community and intense, direct educational campaigns. Although condoms used with nonoxynol-9 spermicide reduce markedly the likelihood of HIV transmission, heterosexual spread of HIV has not been curtailed. Particularly difficult to reach groups are bisexual men, prostitutes using oral contraceptives, heterosexuals already infected with sexually transmitted diseases, especially chancroid, herpes and syphilis, and young people. In Sweden, needle exchange programs have contained AIDS spread abruptly. Paradoxical effects of fear of AIDS in the drug community have worsened the situation in the U.S. For example, fear that heroin causes AIDS has increased the use of cocaine, with its more demanding addiction, that ultimately spreads HIV more rapidly by sexual routes. Spread of HIV by blood products and to health care workers has become a very rare event recently in the U.S. There is hope that the health message is being articulated more effectively, easing fear and enhancing the response by individuals at risk.