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April 12, 1995, Vol 273, No. 14 >
ARTICLE | April 12, 1995

Prevention of HIV Infection: Title and subTitle BreakLooking Back, Looking Ahead FREE

Jeff Stryker; Thomas J. Coates, PhD; Pamela DeCarlo; Katherine Haynes-Sanstad, MBA; Mike Shriver; Harvey J. Makadon, MD
[+] Author Affiliations

Portions of this article were presented by Dr Coates at the Centers for Disease Control and Prevention as the keynote address for the Charles C. Shephard Award ceremonies.

Corresponding author: Jeff Stryker, Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California, San Francisco, 74 New Montgomery, Suite 600, San Francisco, CA 94105.


JAMA. 1995;273(14):1143-1148. doi:10.1001/jama.1995.03520380079039
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Article
References

For some, the occurrence of as many as 40 000 new human immunodeficiency virus (HIV) infections in the United States each year is evidence that HIV education and prevention efforts have failed. To the contrary, more than a decade of experience with HIV has demonstrated that lasting changes in behavior needed to avoid infection can occur as a result of carefully tailored, targeted, credible, and persistent HIV risk-reduction efforts. Given experience in other health behavior change endeavors, no interventions are likely to reduce the incidence of HIV infection to zero; indeed, insisting on too high a standard for HIV risk-reduction programs may actually undermine their effectiveness. A number of social, cultural, and attitudinal barriers continue to thwart the implementation of promising HIV risk-reduction programs. The remote prospects for a successful prophylactic vaccine for HIV and the difficulty in finding effective drug treatments have underscored the importance of sustained attention to HIV prevention and education. A series of "correlates of immunity" are identified— precedents that must exist to establish effective HIV prevention programs. These include sound policies promoting HIV risk reduction; access to health and social services, condoms, needles, and syringes; interventions shown to motivate behavioral change; organizations capable of reaching those at risk; and development and diffusion of technologies to interrupt the spread of the virus.

(JAMA. 1995;273:1143-1148)

REFERENCES

1 +
Mascola JR, McNeil JG, Burke DS.  AIDS vaccines: are we ready for human efficacy trials? JAMA . 1994;;272:488-489.
2 +
Centers for Disease Control and Prevention.  Projections of the number of persons diagnosed with AIDS and the number of immunosuppressed HIV-infected persons—United States, 1992-1994. MMWR Morb Mortal Wkly Rep . 1993;;41( (RR-18) ): 1-29.
3 +
Centers for Disease Control and Prevention.  Acquired immunodeficiency syndrome—United States, 1994. MMWR Morb Mortal Wkly Rep . 1995;;44:64-67.
4 +
Centers for Disease Control.  HIV prevalence estimates and AIDS case projections for the United States. MMWR Morb Mortal Wkly Rep . 1990;;39 ( (RR-16) ):1-31.
5 +
Lifson AR.  Preventing HIV: have we lost our way? Lancet . 1994;;343:1306-1308.
6 +
Philipson TJ, Posner RA, Wright JH.  Why AIDS prevention programs don't work. Issues Sci Technol . 1994;;10:33-35.
7 +
Cates W, Hinman AR.  AIDS and absolutism: the demand for perfection in prevention. N Engl J Med . 1992;;327:492-494.
8 +
Kaplan EH, Abramson PR.  So what if the program ain't perfect? a mathematical model of AIDS education. Eval Rev . 1989;;13:107-122.
9 +
Kelly JA, Murphy DA, Sikkema KJ, Kalichman SC.  Psychological interventions to prevent HIV infection are urgently needed. Am Psychol . 1993;; 48:1023-1034.
10 +
San Francisco Department of Public Health, Surveillance Branch, AIDS Office. HIV Incidence and Prevalence in San Francisco in 1992: Summary Report From an HIV Consensus Meeting . San Francisco, Calif: San Francisco Department of Public Health; February 12,1992.
11 +
Choi KH, Coates TJ.  Prevention of HIV infection. AIDS . 1994;;8:1371-1389.
12 +
Higgins DL, Galavotti C, O'Reilly KR, et al.  Evidence for the effects of HIV antibody counseling and testing on risk behaviors. JAMA . 1991;;266: 2419-2429.
13 +
Lurie P, Reingold AL, Bowser B, et al. The Public Health Impact of Needle Exchange Programs in the United States and Abroad . Rockville, Md: CDC National AIDS Clearinghouse; 1993;.
14 +
Wiebel W, Jimenez A, Johnson W, Ouellet L, Murray J, O'Brien M. Positive effect on HIV seroconversion of street outreach intervention with IDU in Chicago, 1988-1992. Presented at the Ninth International Conference on AIDS; June 7, 1993; Berlin, Germany. Presentation WS-C15-2.
15 +
National Institute on Drug Abuse.  The National AIDS Demonstration Research (NADR) Project. Effectiveness of AIDS Outreach Intervention/Prevention Research Projects in Out-of-Treatment Injection Drug Users . Rockville, Md: National Institute on Drug Abuse, Division of Clinical Research, Community Research Branch; 1994;.
16 +
Allen S, Serufilia A, Bogaerts J, et al.  Confidential HIV testing and condom promotion in Africa: impact on HIV and gonorrhea rates. JAMA . 1992;;268:3338-3343.
17 +
Kamenga M, Ryder RW, Jingu M, et al.  Evidence of marked sexual behavior change associated with low HIV-1 seroconversion in 149 married couples with discordant HIV-1 serostatus: experience at an HIV counselling center in Zaire. AIDS . 1991;;5:61-67.
18 +
Wasserfallen F, Stutz ST, Summermatter D, Hausermann M, Dubois-Arber F. Six years of promotion of condom use in the framework of the National Stop AIDS Campaign: experiences and results in Switzerland. Presented at the Ninth International Conference on AIDS; June 10, 1993; Berlin, Germany. Presentation WS-D27-3.
19 +
World Health Organization. Effective Approaches to AIDS prevention: conclusions of a meeting of the World Health Organization/Global Programme on AIDS/Intervention Development and Support ; May 26-29, 1992;; Geneva, Switzerland.
20 +
Ferreros C, Mivumbi N, Kakera K, Price J. Social marketing of condoms for AIDS prevention in developing countries: the Zaire experience. Presented at the Sixth International Conference on AIDS; June 20-23, 1990; San Francisco, Calif. Abstract SC 697.
21 +
Kirby D, Short L, Collins J, et al.  School-based programs to reduce sexual risk behaviors: a review of effectiveness. Public Health Rep . 1994;;109:339-360.
22 +
Gorman M, Mallon D.  The role of a community-based health education program in the prevention of AIDS. Med Anthropol . 1989;;10:159-166.
23 +
Moatti JP, Dab W, Loundon H, et al.  Impact on the general public of media campaigns against AIDS: a French evaluation. Health Policy . 1992;;21:233-247.
24 +
McGinnis JM, Foege WH.  Actual causes of death in the United States. JAMA . 1993;;270:2207-2212.
25 +
Merson MH. Global status of the HIV/AIDS epidemic and the response. Presented at the 10th International Conference on AIDS; August 8,1994; Yokohama, Japan. Presentation PS1.
26 +
Ekstrand ML, Coates TJ.  Maintenance of safer sexual behaviors and predictors of risky sex: the San Francisco Men's Health Study. Am J Public Health . 1990;;80:973-977.
27 +
Stall R.  How to lose the fight against AIDS among gay men. BMJ . 1994;;309:685-686.
28 +
Fishbein M, Trafimow D, Francis C, et al.  AIDS knowledge, attitudes, beliefs, and practices (KABP) in two Caribbean countries: a comparative analysis. J Appl Soc Psychol . 1993;;23:687-702.
29 +
National Commission on AIDS. Behavioral and Social Sciences and the HIV/AIDS Epidemic . Washington, DC: National Commission on AIDS; 1993;.
30 +
Hahn RA.  What should behavioral scientists be doing about AIDS? Soc Sci Med . 1991;;33:1-3.
31 +
Des Jarlais D, Friedman S.  AIDS and legal access to sterile drug injection equipment. Ann Am Acad Polit Soc Sci . 1992;;521:42-65.
32 +
Burris S.  Education to reduce the spread of HIV.  In: Burris S, Dalton HL, Miller JL, et al, eds. AIDS Law Today: A New Guide for the Public . New Haven, Conn: Yale University Press; 1993;.
33 +
Stryker J, Samuels SE, Smith MD.  Condom availability in the schools: the need for improved program evaluations. Am J Public Health . 1994;; 84:1901-1906.
34 +
Shriver M. The five correlates of immunity. Presented at the meeting of HIV Prevention: Looking Back, Looking Ahead, Prevention Program Committee; April 28, 1994; Washington, DC.
35 +
Rosenberg PS, Biggar RJ, Goedert JJ.  Declining age at HIV infection in the United States. N Engl J Med . 1994;;330:789-790.
36 +
Kegeles SM, Hays RB, Coates TJ.  The Mpowerment project: a community level HIV prevention intervention for young gay and bisexual men. Am J Public Health . In press.
37 +
Catania JA, Coates TJ, Stall R, et al.  Prevalence of AIDS-related risk factors and condom use in the United States. Science . 1993;;258:1101-1106.
38 +
Choi J-H, Rickman R, Catania JA.  What heterosexual adults believe about condoms. N Engl J Med . 1994;;331:406-407.
39 +
Rabin SA.  A private sector view of health, surveillance, and communities of color. Public Health Rep . 1994;;195:42-45.
40 +
Ramah M, Cassidy CM.  Social marketing and prevention of AIDS.  In: Sepulveda J, Fineberg H, Mann J, eds. AIDS: Prevention Through Education: A World View . New York, NY: Oxford University Press; 1992;.
41 +
Fife D, Mode C.  AIDS prevalence by income group in Philadelphia. J Acquir Immune Defic Syndr . 1992;;6:1111-1115.
42 +
Global AIDS Policy Coalition. Towards a New Health Strategy for AIDS . Cambridge, Mass: Global AIDS Policy Coalition; 1994;.
43 +
Centers for Disease Control and Prevention.  HIV prevention practices of primary care physicians—United States, 1992. MMWR Morb Mortal Wkly Rep . 1994;;42:988-992.
44 +
Gerbert B, Maguire BT, Coates TJ.  Are patients talking to their physicians about AIDS? Am J Public Health . 1990;;80:467-469.
45 +
National Commission on AIDS. The Challenge of HIV/AIDS in Communities of Color . Washington, DC: National Commission on AIDS; 1993;.
46 +
Bayer R.  AIDS prevention and cultural sensitivity: are they compatible? Am J Public Health . 1994;;84:895-898.
47 +
Stevenson HC, White JJ.  AIDS prevention struggles in ethnocultural neighborhoods: why research partnerships with community based organizations can't wait. AIDS Educ Prev . 1994;;6:126-139.
48 +
Perrow C, Guillén MF. The AIDS Disaster: The Failure of Organizations in New York and the Nation . New Haven, Conn: Yale University Press; 1990;.
49 +
AIDS Action Foundation. HIV Preventive Vaccines: Social, Ethical, and Political Considerations for Domestic Efficacy Trials . Washington, DC: AIDS Action Foundation; 1994;.
50 +
Cohen J.  A 'Manhattan Project' for AIDS? Science . 1993;;259:1112-1114.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Mascola JR, McNeil JG, Burke DS.  AIDS vaccines: are we ready for human efficacy trials? JAMA . 1994;;272:488-489.
2 +
Centers for Disease Control and Prevention.  Projections of the number of persons diagnosed with AIDS and the number of immunosuppressed HIV-infected persons—United States, 1992-1994. MMWR Morb Mortal Wkly Rep . 1993;;41( (RR-18) ): 1-29.
3 +
Centers for Disease Control and Prevention.  Acquired immunodeficiency syndrome—United States, 1994. MMWR Morb Mortal Wkly Rep . 1995;;44:64-67.
4 +
Centers for Disease Control.  HIV prevalence estimates and AIDS case projections for the United States. MMWR Morb Mortal Wkly Rep . 1990;;39 ( (RR-16) ):1-31.
5 +
Lifson AR.  Preventing HIV: have we lost our way? Lancet . 1994;;343:1306-1308.
6 +
Philipson TJ, Posner RA, Wright JH.  Why AIDS prevention programs don't work. Issues Sci Technol . 1994;;10:33-35.
7 +
Cates W, Hinman AR.  AIDS and absolutism: the demand for perfection in prevention. N Engl J Med . 1992;;327:492-494.
8 +
Kaplan EH, Abramson PR.  So what if the program ain't perfect? a mathematical model of AIDS education. Eval Rev . 1989;;13:107-122.
9 +
Kelly JA, Murphy DA, Sikkema KJ, Kalichman SC.  Psychological interventions to prevent HIV infection are urgently needed. Am Psychol . 1993;; 48:1023-1034.
10 +
San Francisco Department of Public Health, Surveillance Branch, AIDS Office. HIV Incidence and Prevalence in San Francisco in 1992: Summary Report From an HIV Consensus Meeting . San Francisco, Calif: San Francisco Department of Public Health; February 12,1992.
11 +
Choi KH, Coates TJ.  Prevention of HIV infection. AIDS . 1994;;8:1371-1389.
12 +
Higgins DL, Galavotti C, O'Reilly KR, et al.  Evidence for the effects of HIV antibody counseling and testing on risk behaviors. JAMA . 1991;;266: 2419-2429.
13 +
Lurie P, Reingold AL, Bowser B, et al. The Public Health Impact of Needle Exchange Programs in the United States and Abroad . Rockville, Md: CDC National AIDS Clearinghouse; 1993;.
14 +
Wiebel W, Jimenez A, Johnson W, Ouellet L, Murray J, O'Brien M. Positive effect on HIV seroconversion of street outreach intervention with IDU in Chicago, 1988-1992. Presented at the Ninth International Conference on AIDS; June 7, 1993; Berlin, Germany. Presentation WS-C15-2.
15 +
National Institute on Drug Abuse.  The National AIDS Demonstration Research (NADR) Project. Effectiveness of AIDS Outreach Intervention/Prevention Research Projects in Out-of-Treatment Injection Drug Users . Rockville, Md: National Institute on Drug Abuse, Division of Clinical Research, Community Research Branch; 1994;.
16 +
Allen S, Serufilia A, Bogaerts J, et al.  Confidential HIV testing and condom promotion in Africa: impact on HIV and gonorrhea rates. JAMA . 1992;;268:3338-3343.
17 +
Kamenga M, Ryder RW, Jingu M, et al.  Evidence of marked sexual behavior change associated with low HIV-1 seroconversion in 149 married couples with discordant HIV-1 serostatus: experience at an HIV counselling center in Zaire. AIDS . 1991;;5:61-67.
18 +
Wasserfallen F, Stutz ST, Summermatter D, Hausermann M, Dubois-Arber F. Six years of promotion of condom use in the framework of the National Stop AIDS Campaign: experiences and results in Switzerland. Presented at the Ninth International Conference on AIDS; June 10, 1993; Berlin, Germany. Presentation WS-D27-3.
19 +
World Health Organization. Effective Approaches to AIDS prevention: conclusions of a meeting of the World Health Organization/Global Programme on AIDS/Intervention Development and Support ; May 26-29, 1992;; Geneva, Switzerland.
20 +
Ferreros C, Mivumbi N, Kakera K, Price J. Social marketing of condoms for AIDS prevention in developing countries: the Zaire experience. Presented at the Sixth International Conference on AIDS; June 20-23, 1990; San Francisco, Calif. Abstract SC 697.
21 +
Kirby D, Short L, Collins J, et al.  School-based programs to reduce sexual risk behaviors: a review of effectiveness. Public Health Rep . 1994;;109:339-360.
22 +
Gorman M, Mallon D.  The role of a community-based health education program in the prevention of AIDS. Med Anthropol . 1989;;10:159-166.
23 +
Moatti JP, Dab W, Loundon H, et al.  Impact on the general public of media campaigns against AIDS: a French evaluation. Health Policy . 1992;;21:233-247.
24 +
McGinnis JM, Foege WH.  Actual causes of death in the United States. JAMA . 1993;;270:2207-2212.
25 +
Merson MH. Global status of the HIV/AIDS epidemic and the response. Presented at the 10th International Conference on AIDS; August 8,1994; Yokohama, Japan. Presentation PS1.
26 +
Ekstrand ML, Coates TJ.  Maintenance of safer sexual behaviors and predictors of risky sex: the San Francisco Men's Health Study. Am J Public Health . 1990;;80:973-977.
27 +
Stall R.  How to lose the fight against AIDS among gay men. BMJ . 1994;;309:685-686.
28 +
Fishbein M, Trafimow D, Francis C, et al.  AIDS knowledge, attitudes, beliefs, and practices (KABP) in two Caribbean countries: a comparative analysis. J Appl Soc Psychol . 1993;;23:687-702.
29 +
National Commission on AIDS. Behavioral and Social Sciences and the HIV/AIDS Epidemic . Washington, DC: National Commission on AIDS; 1993;.
30 +
Hahn RA.  What should behavioral scientists be doing about AIDS? Soc Sci Med . 1991;;33:1-3.
31 +
Des Jarlais D, Friedman S.  AIDS and legal access to sterile drug injection equipment. Ann Am Acad Polit Soc Sci . 1992;;521:42-65.
32 +
Burris S.  Education to reduce the spread of HIV.  In: Burris S, Dalton HL, Miller JL, et al, eds. AIDS Law Today: A New Guide for the Public . New Haven, Conn: Yale University Press; 1993;.
33 +
Stryker J, Samuels SE, Smith MD.  Condom availability in the schools: the need for improved program evaluations. Am J Public Health . 1994;; 84:1901-1906.
34 +
Shriver M. The five correlates of immunity. Presented at the meeting of HIV Prevention: Looking Back, Looking Ahead, Prevention Program Committee; April 28, 1994; Washington, DC.
35 +
Rosenberg PS, Biggar RJ, Goedert JJ.  Declining age at HIV infection in the United States. N Engl J Med . 1994;;330:789-790.
36 +
Kegeles SM, Hays RB, Coates TJ.  The Mpowerment project: a community level HIV prevention intervention for young gay and bisexual men. Am J Public Health . In press.
37 +
Catania JA, Coates TJ, Stall R, et al.  Prevalence of AIDS-related risk factors and condom use in the United States. Science . 1993;;258:1101-1106.
38 +
Choi J-H, Rickman R, Catania JA.  What heterosexual adults believe about condoms. N Engl J Med . 1994;;331:406-407.
39 +
Rabin SA.  A private sector view of health, surveillance, and communities of color. Public Health Rep . 1994;;195:42-45.
40 +
Ramah M, Cassidy CM.  Social marketing and prevention of AIDS.  In: Sepulveda J, Fineberg H, Mann J, eds. AIDS: Prevention Through Education: A World View . New York, NY: Oxford University Press; 1992;.
41 +
Fife D, Mode C.  AIDS prevalence by income group in Philadelphia. J Acquir Immune Defic Syndr . 1992;;6:1111-1115.
42 +
Global AIDS Policy Coalition. Towards a New Health Strategy for AIDS . Cambridge, Mass: Global AIDS Policy Coalition; 1994;.
43 +
Centers for Disease Control and Prevention.  HIV prevention practices of primary care physicians—United States, 1992. MMWR Morb Mortal Wkly Rep . 1994;;42:988-992.
44 +
Gerbert B, Maguire BT, Coates TJ.  Are patients talking to their physicians about AIDS? Am J Public Health . 1990;;80:467-469.
45 +
National Commission on AIDS. The Challenge of HIV/AIDS in Communities of Color . Washington, DC: National Commission on AIDS; 1993;.
46 +
Bayer R.  AIDS prevention and cultural sensitivity: are they compatible? Am J Public Health . 1994;;84:895-898.
47 +
Stevenson HC, White JJ.  AIDS prevention struggles in ethnocultural neighborhoods: why research partnerships with community based organizations can't wait. AIDS Educ Prev . 1994;;6:126-139.
48 +
Perrow C, Guillén MF. The AIDS Disaster: The Failure of Organizations in New York and the Nation . New Haven, Conn: Yale University Press; 1990;.
49 +
AIDS Action Foundation. HIV Preventive Vaccines: Social, Ethical, and Political Considerations for Domestic Efficacy Trials . Washington, DC: AIDS Action Foundation; 1994;.
50 +
Cohen J.  A 'Manhattan Project' for AIDS? Science . 1993;;259:1112-1114.

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