U.S. lags in nationwide programs against HIV/AIDS

December 19, 1999

Countries as diverse as Switzerland and Thailand outshine the United States in development and implementation of effective nationwide programs against HIV and AIDS, according to recent research.

Although small group and community-level programs have reduced HIV risk in "at-risk" groups, nationwide programs have been deployed rarely in the U.S., according to Michael Carey, PhD, professor of psychology and director of the Center for Health and Behavior at Syracuse University, New York.

HIV/AIDS continues as a worldwide, public health threat, infecting more than 50 million people by the end of 1999. Through December 1998, approximately 688,200 Americans had been diagnosed with AIDS, with two-thirds of them now deceased.

"Infection rates escalated in the 1980s due to initial uncertainty regarding the cause of the disease and later to political reluctance to contribute resources to prevention," said Carey. "Grass-roots activism, coupled with behavioral research advances, helped contain the U.S. epidemic. Years of prevention efforts and treatment advances are reflected in recent declines in new infections among gay men."

According to the researcher, America's reluctance to address sexual health starts in the public school system. Programs here often are information-based and abstinence-oriented. More effective efforts emphasize real-world situations. They include specific strategies to reduce risk behavior, address social and media pressures, and develop communication skills. Carey cites a 1993 study of 1,300 New York City high school students, where a comprehensive program resulted in reduced risk behavior.

Carey points out that at the national level, what has been done remains mostly unevaluated, such as the 1987 AIDS brochure mailed by the Surgeon General to US households. The results of his research appear in the November/December issue of the American Journal of Health Promotion.

Experts call for a national system of sexually transmitted disease protection, but so far, nothing in the U.S. approaches the national AIDS prevention program in Switzerland. Combining informational brochures distributed to all households and special organizations to target at-risk groups, the Swiss program showed about a 20 percent increase in condom use among young adults. In Thailand, a national policy mandating condom use in brothels increased use to more than 90 percent and nearly halved HIV prevalence among military conscripts.

"When lifetime medical costs of treating a person with HIV are considered, economic benefits of HIV prevention programs are significant. They increase when efforts are targeted at high-risk populations," says Carey.

The research was supported by grants from the National Institute of Mental Health.
The American Journal of Health Promotion is a bimonthly peer-reviewed journal dedicated to the field of health promotion. For information about the journal call (248) 682-0707 or visit the journal's website at www.healthpromotionjournal.com .

Posted by the Center for the Advancement of Health < http://www.cfah.org >. For information about the Center, call Petrina Chong, < pchong@cfah.org > (202) 387-2829.

Center for Advancing Health

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