America Living With AIDS

Prevention and Education

Across categories of exposure, individuals for whom condoms might
reduce risk report only limited consistent use of them. Condoms must be
made more widely available and information on how they can be effectively
used must be provided. Further, their
use must be promoted through
sophisticated social marketing strategies. The de facto ban on network
television advertising of condoms continues to impede their social acceptability. These and other impediments
to the use of condoms should be recognized and addressed. More behavioral research is needed to develop
methods of HIV prevention during
sexual contact that are acceptable to
both women and men.
While attempts to promote greater
use of condoms to reduce transmission
of HIV should continue, it is equally
important that research funds and personnel be devoted to the exploration of
alternative methods of preventing HIV
transmission. Increased efforts are
necessary to develop a wider array of
chemical and physical barriers to block
vaginal HIV transmission that do not
depend entirely on the male partner's
cooperation. These include gels, suppositories, or sponges that might be
used before or after intercourse. More
research is needed on chemicals that
kill viruses (virucides). A female condom is also in development. The
diaphragm should be evaluated in
terms of its potential role in HIV prophylaxis.
In considering alternatives to condoms that might be more relevant for
women, it is important to consider

not only efficacy (the probability of
preventing HIV transmission given
optimal or correct use of a prevention
technique or device), but also effectiveness (efficacy plus the extent to which
the device or technique will be used
correctly and therefore contribute to a
slowing of the epidemic). Even surefire methods of prevention are worthless unless people are willing to use
them.
Teenagers tend to deny risk. Yet,

even when they recognize
the risks of HIV, many
adolescents still feel they
are invincible or discount
the risk of HIV because
other risks in their environment are perceived as
greater and more immediate. Adolescents are at
risk, not only from their
own perceptions of lack
of risk, but also because
adults often ignore the
special needs of adolescents or deny that adolescents are sexually active.
Abstinence is an efficacious means of eliminating the risk of sexual
transmission of HIV. Howe

The hopelessness
that is connected with adult
life for young minority people
is a future of which they are
aware. If we don't change the
fact that they have no hopeful
future, I'm not sure we can
take the pressure off the wish to
find whatever joyous escape
exists in the present.
MINDY FULLILOVE, M.D.
March 1991

although many young people have
been encouraged to delay intercourse
until marriage or adulthood, some
teenagers will choose to begin sexual
behaviors during adolescence. In fact,
studies in 1988 revealed that by age 15,

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