America Living With AIDS

E R ICA Livin

cies should be developed now to
address future plans for the distribution of AIDS vaccines as well as the
ethical and liability issues that will
arise when vaccines become available.
A DISEASE OF BEHAVIORS:
CLINICAL AND EPIDEMIOLOGIC
ASPECTS OF HIV
When considering prevention strategies to alter the course of the HIV epidemic it is important to keep in mind
the manner in which the virus is
transmitted. The limited modes of
transmission of HIV have been well
documented. HIV can be transmitted
through sexual contact; by the sharing
of contaminated injection equipment;
through exposure to infected blood or
blood products; and, during gestation
or at birth, from an infected mother to
a newborn. Breastfeeding has also
been identified as a potential mode of
transmission.
Understanding these modes of
transmission has enabled the development of some practical strategies for
use in stopping the spread of the virus.
Screening of blood and voluntary
deferral of blood donors at risk of HIV
infection has significantly reduced the
transmission of HIV through the
blood supply. Sophisticated purification techniques, blood screening, and
voluntary self-deferral have eliminated
new HIV infections from occurring
through the use of blood clotting factors to people with hemophilia. "Universal precautions" can help patients
and health care workers avoid expo
sure to HIV. Such precautions involve
the avoidance of all potentially infected blood or body fluids through barrier methods, without regard to the
serostatus of patients or health care
workers. The efficacy of universal precautions can be strongly inferred by a
substantial drop in hepatitis B transmission (hepatitis is a hundred times
more infectious than HIV). Appropriate use of condoms can decrease
the risk of HIV during sexual intercourse. It is also possible to disinfect
injection equipment with bleach so
that the sharing of needles and
syringes does not spread the virus.
In addition to the strategies available to prevent new infections, much
more is now known about how to
delay progression to AIDS in HIVinfected individuals. Until a few years
ago, treatment regimens for HIV disease had been offered only to those
exhibiting symptoms. In recent years,
the clinical management of HIV disease has improved with the development of therapeutic strategies involving the use of treatments such as
zidovudine (AZT) and aerosolized
pentamidine for HIV-infected individuals who are still asymptomatic. This
early intervention has enhanced wellbeing in addition to delaying the onset
of AIDS, but its availability or lack
thereof raises important issues of
access. To bring the benefits of early
intervention to people in need, additional and better coordinated services
will be required-not only greater
outreach, HIV testing, counseling,
laboratory monitoring, medications,
and primary health care, but also
improved laboratory services, better

20