America Living With AIDS

AM E R I C A Living With AIDS

Unfortunately, the findings of research
on HIV education and behavioral
interventions are only partially applied
because of restrictions placed on prevention messages by the U.S.
Congress. In the area of prevention, it
is also important that the United
States consider adopting successful
prevention models developed in other
countries. Examples would include
sexual education programs in Scandinavia that have led to low rates of sexually transmitted diseases and unintended pregnancies (though rates of
sexual activity are comparable to the
United States) and programs of overthe-counter sales of needles and needle exchanges throughout Europe and
Australia that have reduced needle
sharing without leading to increased
intravenous drug use.
A COMPREHENSIVE NATIONAL
HIV PREVENTION INITIATIVE
The federal government should establish a comprehensive national HIV
prevention initiative that integrates
the approaches of federal, state, county, and municipal government; community-based organizations; the private sector; and affected populations.
This strategy should ensure both central coordination and local autonomy.
At the federal level, a plan should be
established within the Public Health
Service and across other federal agencies to coordinate development of
effective HIV prevention programs,

rather than allowing each agency or
institute to pursue potentially idiosyncratic activities. Emphasis should be
placed on linking health care and prevention efforts. The Commission
stresses the urgent need for implementation of carefully designed strategies to prevent new HIV infections
and to prevent disease progression for
HIV-infected individuals through
early diagnosis, prompt treatment,
and continuing care and support.
Offering advice about changes in
behavior and making referrals to education, counseling, and prevention
services is a critical aspect of delivering HIV care.
Although some states and localities
have built infrastructures to enable
them to mount effective primary and
secondary prevention programs, others have not. Community-based organizations, often the heart of primary
prevention efforts, are even less likely
to have the strong administrative and
fiscal structures that would ensure that
their programs remain sound. Many
community-based organizations have
relied upon seed money or demonstration grants from governmental or
private foundation sources. The
fragility of funding streams has made
it difficult to plan, implement, and
evaluate programs, especially for
newer groups in minority communities. Rigid requirements hinder
attempts to develop and sustain meaningful programs. Delayed reimbursements jeopardize the very existence of
community-based organizations,

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