Tailor HIV prevention to patient.(Clinical Rounds)

MIAMI -- HIV prevention efforts should be comprehensive and tailored to individuals on the basis of their serostatus, according to a presentation at a conference sponsored by the American Foundation for AIDS Research.

There is some good news regarding previous prevention efforts. "We have probably averted 200,000 to about 1.5 million infections, enough to fill a moderately sized U.S. city, with prevention efforts," according to David Holtgrave, Ph.D.

One emerging prevention tactic is to study and target the small minority of people who know they are HIV infected but do not change their risk behavior. "In the United States, at least 96% of people living with HIV or AIDS do not transmit their disease.

"We need to better understand the societal, situational, interpersonal, behavioral, and biologic reasons why the 4% transmission still exists," said Dr. Holtgrave, professor of behavioral science at Rollins School of Public Health, Emory University, Atlanta.

The success of HIV prevention efforts is closely related to funding. "As the level of prevention investment increased, we saw a drop in new infections." Essentially, "you get what you pay for," Dr. Holtgrave said. He predicted the next few years would show a slight decline in funding and an expected increase in new cases. The incidence of new HIV infections in the United States peaked at about 160,000 cases per year in the mid-1980s.

Since then, new cases have leveled off at about 40,000 per year. In January 2001, the Centers for Disease Control and Prevention announced its goal to halve the annual number of new infections to 20,000 by 2005, with a particular focus on minorities.

"We will really need about $300 million for 3 or 4 years to make the sustained effort ...