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AIDS in U.S. Marches On

Lack of AIDS Fear, Missed Opportunities Hinder Prevention Efforts

Missed Opportunities continued...

These opportunities still exist. But as might be expected in a disease spread by sex and drug use, they are highly controversial.

One of these opportunities is the idea of allowing injection drug users to exchange dirty, possibly HIV-contaminated needles and syringes for new ones -- no questions asked.

"We found that in the U.S., that one thing alone -- needle and syringe exchange -- could probably prevent more than 12,000 of the 40,000 new HIV infections each year," Holtgrave says. "That is a good example of having a tool you know is quite useful and leaving it on the shelf rather than using it."

Huebner, too, expresses frustration over this issue.

"Needle and syringe exchange is an empirically proven effective intervention," he says. "We know it works -- and in the U.S., it is illegal to do with federal funds."

Another issue is teaching effective condom use.

"Everywhere but California, it is illegal to teach condoms in public schools," Huebner says. "That is ridiculous. How do we expect people to protect themselves if they do not get the information they need?"

More Effective HIV Prevention

Condoms, Huebner is quick to point out, certainly are effective in preventing HIV transmission. But they can never be the total solution to safe sex.

"Condoms change sex dramatically," Huebner notes. "If we tell people they have to do something that makes sex less pleasurable forever, that is a hard message to get across. Condoms are not a viable solution over the human lifespan."

Abstinence -- refraining from sex until marriage -- is another highly effective means of preventing HIV. But abstinence, like condom use, is not a lifelong solution. And at least one part of the U.S. population has little to gain by waiting until marriage.

"We live in a society where gay men cannot enjoy the benefits of marriage," Huebner says. "At my sister's wedding last week, 250 people came to support them. And that does not occur for gay men. This kind of social support is a very powerful incentive for heterosexuals to be faithful and to stay together. Without that incentive, it is harder for gay men. They don't get that kind of support."

Needle exchange, effective sex education, and gay marriage make for a pretty controversial prevention agenda.

"The next frontier in AIDS prevention is to make changes to society that support people to be healthy and make healthy choices," Huebner says. "Currently, that is difficult."

Holtgrave, too, calls for changes in our approach to HIV prevention. He takes a pragmatic approach. Current HIV prevention programs succeed by targeting prevention messages to specific populations. It's effective, Holtgrave says -- but a different targeting strategy could work even better.

"For years we have been custom-tailoring prevention messages on the basis of sexual orientation, socio-demographic status, substance abuse history, race and ethnicity, and geography," he says. "We want to include in that list a person's HIV status. Whether they are aware of status, whether they are negative at low or high risk, or whether they are positive determines the messages to which they respond. For each of those four populations, a different set of services may be necessary."

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