[AIDS prevention in Germany - a successful model in crisis]

The rising number of new HIV infections in Germany, particularly among men who have sex with men, raises the question whether the previously successful prevention strategy should be revised. This strategy has been based on a New Public Health approach which arose from the specific historical context in Europe at the start of the epidemic. The hallmarks of this approach are: the active involvement of the target groups; the central role of non-governmental organizations; the combination of population level and targeted, context specific interventions; and an emphasis on social integration and voluntary participation in the work with target group members. Current challenges include: changes in risk perception (at least in part due to the availability of more effective treatments); a diversification of prevention behavioral strategies among target group members; the formation of new sexual subcultures and target groups; as well as changes in hard-to-reach populations such as immigrants and people of lower socioeconomic status. In order to meet these challenges the following measures are necessary: an increased investment in prevention research (with a particular focus on interventions specific to social contexts in which risk behavior is increasing); further development of the institutional infrastructure for prevention, including the full implementation of UNAIDS guidelines for national prevention strategies; and improving the prevention work of local AIDS service organizations and public health authorities through an increase in funding and the implementation of quality assurance measures based on participatory action research.