1. Preventive interventions are effective for reducing behavioral risk for HIV/AIDS and must be widely disseminated. Their application in practice settings may require careful training of personnel, close monitoring of the fidelity of procedures, and ongoing monitoring of effectiveness. Results of this evaluation must be reported; and where effectiveness in field settings is reduced, program modifications must be undertaken immediately.

   Three approaches are particularly effective for risk in drug abuse behavior: needle exchange programs, drug abuse treatment, and outreach programs for drug abusers not enrolled in treatment. Several programs were deemed effective for risky sexual behavior. These programs include (1) information about HIV/AIDS and (2) building skills to use condoms and to negotiate the interpersonal challenges of safer sex. Effective safer sex programs have been developed for men who have sex with men, for women, and for adolescents.

2. The epidemic in the United States is shifting to young people, particularly those who are gay and who are members of ethnic minority groups. New research must focus on these emerging risk groups. Interventions must be developed and perfected, and special attention must be given to long-term maintenance of effects. In addition, AIDS is steadily increasing in women, and transmission of HIV virus to their children remains a major public health problem. Interventions focused on their special needs are essential.

3. Regional tracking of changes in behavioral risk will be necessary to identify settings, subpopulations, and geographical regions with special risk for seroconversion to HIV-positive status as the epidemic continues to change. This effort, if properly coordinated with National tracking strategies, could play a critical part in a U.S. strategy to contain the spread of HIV.

4. Programs must be developed to help individuals already infected with HIV to avoid risky sexual and substance abuse behavior. This National priority will become more pressing as new biological treatments prolong life. Thus, prevention programs for HIV-positive people must have outcomes that can be maintained over long periods of time, in order to slow the spread of infection.

5. Legislative restriction on needle exchange programs must be lifted. Such legislation constitutes a major barrier to realizing the potential of a powerful approach and exposes millions of people to unnecessary risk.

6. Legislative barriers that discourage effective programs aimed at youth must be eliminated. Although sexual abstinence is a desirable objective, programs must include instruction in safe sex behavior, including condom use. The effectiveness of these programs is supported by strong scientific evidence. However, they are discouraged by welfare reform provisions, which support only programs using abstinence as the only goal.

7. The erosion of funding for drug and alcohol abuse treatment programs must be halted. Research data are clear that the programs reduce risky drug and alcohol abuse behavior and often eliminate drug abuse itself. Drug and alcohol abuse treatment is a central bulwark in the Nation's defense against HIV/AIDS.

8. The catastrophic breach between HIV/AIDS prevention science and the legislative process must be healed. Citizens, legislators, political leaders, service providers, and scientists must unite so that scientific data may properly inform legislative process. The study of policy development, the impact of policy, and policy change must be supported by Federal agencies.

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