The HIV prevention challenge.(Guest Editorial)

The need for enhanced HIV prevention efforts by health care providers is greater than ever. An estimated 850,000950,000 people in the United States are living with HIV or AIDS--more than at any point in the epidemic.

The treatment breakthroughs that have enabled HIV-infected individuals to live longer, healthier lives have also led to a belief that HIV is no longer a serious illness, creating a sense of complacency about prevention and resulting in increasing risk behaviors in some populations. New data from the Centers for Disease Control and Prevention from 25 states with long-standing HIV infection case reporting show an 8% increase in the number of HIV diagnoses between 1999 and 2001.

The widespread use of highly active antiretroviral therapy led to a sharp decline in the incidence of AIDS in the United States beginning in 1996. But the declines began to level off in the late 1990s, and in 2001 there was a 1% increase in diagnosed AIDS cases, compared with 2000. This was the first such increase in several years, possibly a result of factors such as treatment failure, lack of access to effective treatment, and late diagnosis of HIV infection resulting in delayed treatment initiation.

Updated findings from the CDC's multistate Supplement to HIV/AIDS Surveillance (SHAS) project indicate that only a small proportion of HIV-infected persons (10% of men and 17% of women) said that their initial HIV testing was suggested by their health care provider. Illness was the most common reason for testing. These findings underscore the need for earlier diagnoses and referrals to treatment, care, and prevention services.

Additional SHAS findings indicate that most HIV-positive individuals are sexually active (69% of 1,656 interviewed at 16 SHAS sites). Condom use among those who were aware of their partner's HIV status ranged from 78% to 96% during their last sexual encounter. These percentages dropped to between 52% and 86% when the ...