AIDS prevention: issues and strategies.

ABSTRACT

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.