America Living With AIDS

AM E R I C A Living With

The medium is
the message. You can't have
safe sex at Cabrini Green
Projects. It's not a safe place.
MICHAEL JAMES
March 1991

ective in discouraging HIV-infected
men from becoming pregnant or
ring children. HIV antibody screenof pregnant women and newborns
es profound moral, legal, and policy
ies that are dealt with at considerable
gth in recent reports on the subject by
Institute of Medicine (1991) and
other policy groups.
All women of childbearing years who are
considering pregnancy or
are pregnant must be
apprised of all the options
available to them-they
must be informed of their
options but not coerced
into any particular decision. Just as much of the
advice to date for women
about how to prevent the
ual transmission of HIV may have
n of little relevance to their lives,.re is a growing realization that
nket advice for HIV-positive
men to avoid becoming pregnant
y not be appropriate. As noted in a
>ort by the Institute of Medicine,
V Screening of Pregnant Women and
wborns, "...limited studies to date
er little evidence to suggest that
awledge of HIV infection status sigicantly affects women's decisions
arding continuation of a pregnancy
future childbearing." For many
men, having children is a large part
being a woman; thus, fully informed

women may decide that it is worth
running the risk of perinatal transmission to give birth.
RESEARCH AND EVALUATION
REGARDING PREVENTION
PROGRAMS
During the first decade of the HIV
epidemic the need for epidemiologic
and behavioral research was recognized. The published literature that
resulted consists primarily of a mosaic
of small-scale studies, examples of
behavioral interventions demonstrated to be effective either in reducing
new HIV infections or in making substantial modifications to high-risk
behaviors in narrowly defined populations. In the earliest phases of the epidemic, a great deal was learned about
appropriate prevention strategies
among those identified to be at risk,
especially white, self-identified gay
men in urban areas.
There remains, however, a lack of
knowledge in several areas crucial to
education and prevention-sexual
and other behavior patterns in people
of varied cultural, racial, and ethnic
groups; frequency of different types of
sexual behavior among adolescents or
adults; family or community
approaches to prevention; technological
approaches to prevention, including
female-based research on virucides and
barrier methods of prevention; largescale studies of needle exchange programs in the United States; and innovative approaches in prevention,
including communitywide approaches.
Greater priority and funding
should be given to behavioral, social

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