PREVENTION OF HIV-INFECTION - LOOKING BACK, LOOKING AHEAD

For some, the occurrence of as many as 40 000 new human immunodeficien cy virus (HIV) infections in the United States each year is evidence t hat HIV education and prevention efforts have failed. To the contrary, more than a decade of experience with HIV has demonstrated that lasti ng changes in behavior needed to avoid infection can occur as a result of carefully tailored, targeted, credible, and persistent HIV risk-re duction efforts. Given experience in other health behavior change ende avors, no interventions are likely to reduce the incidence of HIV infe ction to zero; indeed, insisting on too high a standard for HIV risk-r eduction 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 pr ospects for a successful prophylactic vaccine for HIV and the difficul ty in finding effective drug treatments have underscored the importanc e of sustained attention to HIV prevention and education. A series of ''correlates of immunity'' are identified-precedents that must exist t o establish effective HIV prevention programs. These include sound pol icies promoting HIV risk reduction; access to health and social servic es, condoms, needles, and syringes; interventions shown to motivate be havioral change; organizations capable of reaching those at risk; and development and diffusion of technologies to interrupt the spread of t he virus.