America Living With AIDS

reality of HIV and help overcome the
denial that "this cannot happen to me
or my loved ones." When gay men,
women, people of color, and persons
using drugs are not consulted in the
design and implementation of prevention programs, programs directed
toward these audiences will not be
effective.
STRATEGIES IN HIV
PREVENTION
The Web of Illness, Poverty,
and Alienation
HIV disease is associated with a host
of related health and social problems;
strategies to prevent the further spread
of HIV disease must take these problems into account. Other sexually
transmitted diseases (e.g., syphilis,
gonorrhea, chlamydia, herpes, hepatitis, and venereal warts) may act synergistically with HIV, enhancing HIV
transmission or disease progression.
Drug use is significantly associated
with HIV disease. Injection drug use
poses the most direct threat of HIV
transmission when contaminated
injection equipment is shared; this is a
risk for intravenous users of any drug,
including heroin, cocaine, and
steroids. It has been less widely recognized that crack cocaine, alcohol, and
other psychoactive drugs also represent serious threats when multiple
sexual partners and impaired judgment about risk are involved.
From New York City to Waycross,
Georgia, from San Juan, Puerto Rico,
to Seattle, Washington, in hearings
and site visits the Commission has
seen how poverty, homelessness, lack
of basic health care, lack of prevention

services, and lack of drug treatment
combine with the alienation experienced by gay men, poor women of
color, and drug users to exacerbate the
spread of the virus. A dramatic example of this is the increase in sexually
transmitted diseases in many urban
and rural areas in the United States.
Essential Elements
of Prevention Programs
To intervene effectively in the spread
of HIV it is essential to consider the
broader social context of the HIV epidemic, for it involves not only individuals at risk, but also families, cultural
and social groups, neighborhoods,
and communities at risk
of multiple problems.
Although this adds to the
complexity of HIV intervention, it also means that e
successful HIV prevention
efforts will not only
reduce the spread of HIV, SA
but also are likely to have
an impact on the rates of
other sexually transmitted
diseases, teenage pregnancy, and drug use.
A mix of strategies is being used
throughout the country in the design
of HIV prevention programs. From
grass roots efforts to federally sponsored programs, these varied
approaches draw on a number of different fields, disciplines, perspectives,
and experiences. The potential for
success in prevention is enhanced by