America Living With AIDS

ing, and non-injection drug use,
including alcohol use;
* location or setting such as hospitals,
clinics, prisons, churches, work
environments, and schools;
* other circumstances such as possible
exposure to HIV infection through
blood transfusions or other use of
blood products.
Communitywide models are
designed to utilize multiple settings,
channels, and organizations in their
design, implementation, and evaluation. Each community has distinct
features; no two communities will be
alike in their response to HIV disease,
and thus the process by which a
response to the HIV epidemic is
mobilized in communities will also
vary. Understanding more about how
to respond to AIDS involves understanding and respecting what the
community regards as problems and
priorities, acknowledging social organization and structure, and then identifying the community's available
resources and what solutions it will be
ready to employ. These efforts must
be supported, funded, documented,
and evaluated to broaden the reach of
our prevention efforts. Federal, state,
and local governments should join
forces with the private sector in providing long-term support to community-based organizations. As a part of
this effort, the U.S. Public Health Service (PHS) should expand and promote comprehensive programs for
technical assistance and capacity
building for effective long-term prevention efforts.

REDUCING SEXUAL
TRANSMISSION OF HIV
Substantial progress has been made in
reducing sexual transmission of HIV
infection among certain populations
in some areas of the country. Nevertheless, sexual transmission of HIV continues to
be a major route of infection. Although many
more people are now i
aware of the types of sexu- be
al behaviors that risk the Ft
spread of HIV, the gulf SIi
between awareness of risk
and long-term behavioral
change can be wide. Sexu- HA
al conduct is influenced by Co,
complex factors, including Res
biological drives, religious Vec
beliefs, customs, and cul- Pr
tural and community
norms and values. These n
aspects of sexual behavior Ho
make changes difficult to or A
inculcate. Consider how (th
difficult it is to get people Ro
to stop smoking, even "La
when they know how of I
dangerous it is; or how Ur
much effort it has taken
to encourage people to
wear seat belts, despite
the manifest risks of not
doing so. A psychiatrist m(
who testified before the
H
agc

gnorancia
ecause of i
amilia Hi,
DA" (The
Against Al
SIDA" (Aj
VCER (Th
mmittee ft
ources); P
ino" (NeiS
oject); "IIi
vas a maýi
nuerto?" (
)w will yoz
Llive?); "L,
e Souls of
nda" (Nig
Clinica E
lope); CU
nida en Re
(Commut
Respon,

any m
respo
ispan:
ainst,

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