An overview of HIV prevention in the United States

Despite recent promising results with protease inhibitors and combinations of drugs in treating HIV-infected persons, a cure or vaccine for AIDS is unlikely within the next several years. Therefore, prevention remains the most realistic strategy for dealing with the HIV epidemic. However, HIV prevention efforts in the United States face enormous challenges. Translating knowledge about effective HIV prevention strategies into sound HIV prevention policy must be a priority. For example, AIDS prevention experts must dispel the myth that needle exchange programs for injection drug users encourage drug use. Such programs may, however, decrease the risk for HIV transmission. Another challenge is to implement effective sex education programs. It is well established that early sex education does not lead to promiscuity among young people; in fact, it may actually decrease overall sexual activity and decrease high-risk sexual activities. Finally, prevention programs must reach those most at risk. Surveillance data indicate that these include young gay men, Hispanic and African Americans, and the economically disadvantaged. Prevention policy too often is formed on the basis of opinion or anecdote rather than on the basis of science. Sound and strong science is needed to ensure that the best programs and policies can be put into place.