Introduction

One in 250 people in the United States is infected with the human immunodeficiency virus (HIV), which causes AIDS; AIDS is the leading cause of death among men and women between the ages of 25 and 44. Every year, an additional 40,000­80,000 Americans become infected with HIV, mostly through behaviors that are preventable. In the United States, unsafe sexual behavior among men who have sex with men and unsafe injection practices among drug users still account for the largest number of cases. However, the rate of increase is greater for women than men, and there have been larger annual increases from heterosexual HIV transmission than among men who have sex with men.

The purpose of this conference was to examine what is known about behavioral interventions that are effective with different populations in different settings for the two primary modes of transmission: unsafe sexual behavior and nonsterile injection practices. Experts also provided the international and National epidemiology of HIV and a review of AIDS prevention efforts.

An extensive body of research has led to significant information on how to help individuals change their HIV-related risk behaviors. The interventions studied were based on a variety of models of behavior change, including social learning theory and related health and substance abuse models. The interventions begin with HIV and substance abuse education, but also include skill acquisition, assertiveness training, and behavioral reinforcement components. Recent research leads to the conclusion that aggressive promotion of safer sexual behavior and prevention and treatment of substance abuse could avert tens of thousands of new HIV infections and potentially save millions of dollars in health care costs. To date, however, there has not been widespread agreement among health professionals as to which interventions are most effective, in which settings, and among which populations.

Because behavioral interventions are currently the only effective way of slowing the spread of HIV infection, recommendations coming from this conference have immediate implications for service delivery in health care and educational settings, including schools; substance abuse treatment programs; community-based organizations; sexually transmitted disease clinics; inner-city health programs reaching disenfranchised high-risk women, men, and adolescents; rural health programs; and mental health programs that serve high-risk people with chronic mental illness. Knowing which behavior change interventions are most effective will assist public health personnel in allocating resources.

The conference brought together behavioral and social scientists, prevention researchers, statisticians and research methodologists, clinicians, physicians, nurses, social workers, mental health professionals, other health care professionals, and members of the public.

Following one-and-a-half days of presentations and audience discussion, an independent, non-Federal consensus panel weighed the scientific evidence and developed a draft consensus statement that addressed the following five questions:

• How can we identify the behaviors and contexts that place individuals/communities at risk for HIV?
  
  
• What individual-, group-, or community-based methods of intervention reduce behavioral risks? What are the benefits and risks of these procedures?
  
  
• Does a reduction in these behavioral risks lead to a reduction in HIV?
  
  
• How can risk-reduction procedures be implemented effectively?
  
  
• What research is most urgently needed?

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