HIV infection

Drug use will soon become the major risk for transmission of HIV infection in the United States, which will result in near equal incidence of the disease in men and women and more affected children. This has serious implications for the health care community and for the community at large. Thus, it is necessary to pursue aggressively risk reduction strategies targeted for difficult-to-reach populations such as illicit drug users and commercial sex workers. This will involve a vigorous public health campaign to bring education messages about safer sex practices, safer injection techniques, and enhanced drug treatment services to these groups. Prevention strategies include consideration of needle exchange as a public policy for IDUs. There are appropriate concerns in the larger community that needle exchange might send a mixed message or promote drug use, but there is no scientific evidence to support this view. To the contrary, there is a growing body of evidence that suggests drug users change behavior in response to education messages and that clean needles may reduce disease risk. Currently, stable seroprevalence rates in some IDU populations suggest that education messages about injection practices are heeded. Unfortunately, sexual practices have not shown similar changes. Most, if not all, HIV-infected persons will experience neurologic complications during their illness, especially as improved medical therapy ameliorates systemic complications. The approach to diagnosis and management requires a thorough understanding of the diverse clinical syndromes that may occur and a systematized approach to investigation of the cause.