PRIMARY HIV-INFECTION - A PUBLIC-HEALTH OPPORTUNITY

Primary human immunodeficiency virus (HIV) infection should be conside red a key target for HIV prevention activities. Mathematical models su ggest that the primary HIV infection interval makes a disproportionate contribution to the HIV epidemic, perhaps accounting for as many as h alf of the existing infections at any point in time. if this is true, primary infection presents a special window of opportunity within whic h to exert a maximum impact on the spread of HIV. A contamination of b iological, behavioral, and social factors may account for the influenc e of primary infection on the HIV epidemic. HIV prevention measures ca n be focused on each of these factors. Biologically, detecting individ uals early in the course of infection and offering treatment can reduc e viral load and possibly an individual's infectiousness. Behaviorally , counseling newly infected persons about the importance of adopting s afer practices may instill prevention behaviors at a critical time. So cially, using a network approach to notify persons exposed to those wi th primary infections can dampen the amplification effect of rapid HIV spread through high-risk environments. By focusing prevention efforts on the primary HIV infection interval, public health officials could increase their leverage in slowing the HIV epidemic.