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on AIDS policy, prevention and treatment

Reducing the Spread ofHIV

Who’s At Risk?HIV is a disease of behaviors. For the most part, it is what you do that puts you at risk of AIDS.The basic routes of transmission–unprotected sex, sharing contaminated drug injectionequipment, from infected mothers to their newborn babies, or receiving contaminated blood orblood products–have been known for well over a decade. More than 80 percent of all cases ofAIDS have been among men who have sex with men and injection drug users. Despite a clearunderstanding of how the virus is transmitted,

In 1993, AIDS became the leading cause of death for adults aged 25-44 in the U.S. HIV isincreasingly a disease of the young–one in four new infections occurs in people under age 22.

People of color bear a disproportionate share of the burden of AIDS. African Americans andLatinos together comprise approximately 23% of the U.S. population, yet they account for nearly50% of the AIDS cases.

Comparison of US AIDS Patients (244,372)
(as of 12/31/92) and Estimated 1991 U.S. Population by Race/Ethnicity1118-piechart.gifA White, Non-Hispanic D Asian/Pacific Islander
B Black, Non-Hispanic E American Indian/Alaskan Native
C Hispanic
Source: Centers for Disease Control and Prevention
Gay and bisexual men represent a decreasing percentage of newly diagnosed cases of AIDS, bothbecause their rate of increase has slowed in recent years (1989 through 1994) and because theepidemic is growing more rapidly in other segments of the population. Nevertheless, gay andbisexual men continue to constitute the largest portion of people with newly diagnosed AIDS, sosuccess in controlling the AIDS epidemic depends on preventing new cases among this group.

Approximately one-third of all AIDS cases are linked to injection drug use. For women, 64% ofall AIDS cases are due to injection drug use or sex with partners who inject drugs. Injecting druguse is the source of infection for more than half of all children born with HIV.

AIDS is also a growing problem for women. Women are one of the fastest growing populationsbeing infected with HIV. The number of AIDS cases among women is doubling every one to twoyears. Because of the far greater number of cases among men in the early years of the epidemic,risks to women were often overlooked.

1118-newaids.gifSource: Centers for Disease Control and Prevention Can People Change Their Behaviors?Adopting healthy habits is not always an easy task. Knowledge and awareness of health risks areessential. Surveys show a remarkable degree of awareness regarding the basic facts of HIVtransmission among American adults and teenagers. This is a starting point for behavior change,but, as with other health risks, knowledge alone is unlikely to be sufficient to achieve and sustainthe behavioral changes necessary to avoid HIV transmission.

In the face of the threat of HIV, many have changed their behaviors. Gay and bisexual men madedramatic changes in the rate of unprotected sex and multiple sexual partners in the early years ofthe epidemic. In San Francisco, new infections reached a high of 8,000 in 1982. In 1994, theestimated number of new HIV infections was 1,000. This dramatic reduction in new infections canbe attributed in part to comprehensive community-based HIV prevention efforts aimed at gay andbisexual men that began in the early 1980s.

Injection drug users, despite much conventional wisdom to the contrary, have also changedbehavior, reducing the sharing of injection equipment. The rate of HIV infection among druginjectors varies considerably from city to city ranging anywhere from a few percent to 60 percentor more. This variability underscores the opportunities which remain to decrease the transmissionof HIV among drug injectors, and thereby avoiding further spread to sexual partners andoffspring.

Are HIV Prevention Programs Worthwhile?With prospects for a preventive vaccine still quite remote, HIV prevention and education effortsremain critical to efforts to reduce the numbers of new HIV infections. The case forprevention

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