America Living With AIDS

A M ER I C A Living With

government policies that are not
restrictive and that create a climate in
which prevention efforts can be creative, cooperative, and comprehensive.
Other interventions that have helped
to create a positive context for HIV
prevention efforts include laws guarding confidentiality and protecting
against discrimination. Without
assurances that people can avail themselves of HIV prevention opportunities without risking the loss of jobs,
housing, and health insurance, it is
next to impossible for prevention and
education services to reach those at
greatest risk of HIV.
If prevention efforts are to be successful they require sustained commitment to change over the long term,
rather than an expectation of shortterm results. They also require support of multiple interventions and
strategies, rather than investment in a
single "solution." Support must be
continuous and predictable. Prevention programs must be accountable,
progress and results must be measurable, and training and support must
be provided to those administering
the programs.
Some important prevention strategies include: sex and HIV education
appropriate to age levels; treatment
programs for substance users; education about bleach and clean needle
and syringe programs for those who
are unable to stop using drugs; efforts
to control sexually transmitted diseases; outreach programs to provide
contraception to women of childbearing age; easily accessible HIV antibody testing and essential counseling;

peer counseling; street outreach
efforts; and readily available condoms
supported by a social marketing program that encourages their use.
Individual and Community
Approaches
Efforts designed to control HIV infection create change by intervening at
many levels. Technological approaches will not work without changes in
knowledge, attitudes, beliefs-and
behaviors. In this second decade of
the HIV epidemic, there will be an
increasing need to supplement individual behavior change strategies with
a concept of communitywide prevention. Similar interventions aimed at
changing the norms of entire communities are among the most promising
HIV prevention strategies. These
interventions have proven to be effective in promoting a variety of health
behaviors, such as family planning
and cardiovascular risk reduction,
including smoking cessation.
Communitywide models of HIV
prevention make use of a mix of
strategies. Communities of interest
are defined by more than mere geographical proximity. Communities
may be defined by:
* common identities such as gender,
sexual orientation, race or ethnicity, language, religious affiliation,
age group, or a genetic condition
such as hemophilia;
* behavior such as same-gender sex,
injection drug use or needle shar