AIDS prevention: issues and strategies.

Prospects for vaccines to prevent HIV infection and disease have dimmed appreciably in the past year, and drugs for chemoprophylaxis and/or chemical cure are both unlikely and grossly unrealistic as a means of global HIV control. However, the paucity of transmission routes and their susceptibility to strategies of blood screening and of education for behavior modification point in a clear direction for concerted effort. Where they have been applied, blood screening programs have resulted in a dramatic reduction in transfusion-associated infections, and efforts at enhancing donor- and unit-deferral strategies offer promise of further decrease in risk. There is much encouragement in recent reports of education for prevention. While there has been some unevenness in the extent to which successful risk reeducation has occurred, it is nonetheless dramatic compared with prior health educational efforts, and especially so given the exceptional sensitivity of the sexual and illicit drug using behaviors at issue. Finally, clearly articulated public education and particularly correction of misinformation, can contribute significantly to overall prevention efforts by easing fear and enhancing the climate in which persons at behavioral risk of HIV infection can receive and respond to targeted messages.