making vaccine and drug development essentially impossible. Because of the long development process, vaccines and drugs can contribute little to disease control at the onset of an outbreak of a newly emergent disease. Only in a case in which an effective drug has already been developed for use against another organism and is found be efficacious against the newly discovered agent will drugs be of use in such circumstances.

HIV disease illustrates these problems quite clearly. It has been almost a decade since HIV was isolated, yet there is no vaccine and few drugs that have been shown to slow the disease process. Since the major modes of transmission of HIV are behaviorally based, the pandemic offered a unique opportunity to put public education and behavior modification to use. Initially, officials were highly reluctant to provide candid information to the public on how to prevent the spread of HIV. Recently, however, efforts at education on HIV and AIDS, much of it from nongovernmental organizations, have been more straightforward. Among the more visible of the federal government efforts were the mailing of an AIDS information pamphlet to every household in the country in 1988 and the current television spots that provide a toll-free number to call to learn more about HIV disease. The concern of the committee is that these efforts are targeted to a general audience rather than to specific risk groups, and do not use the terminology that is most understandable to these populations.

Nevertheless, despite a disappointing beginning, the experience with HIV demonstrates that human behavior can be modified in part through education. Condom use has increased and numbers of sexual partners have decreased in most male homosexual populations that have been studied (National Commission on Acquired Immune Deficiency Syndrome, 1991). Evidence for similar behavioral change among those using intravenous drugs or crack cocaine is less encouraging.

Even when scientists and public health officials rely on education and encourage behavioral change to prevent or limit the spread of infectious disease, the public may not be convinced. Although scientists may see emerging microbes as a very real threat to public health, the average citizen may be unaware of the potential danger or may consider those dangers to be less important than other health risks, for example heart disease or cancer. In such instances, carefully conceived media campaigns may have a beneficial effect on behavior in relation to disease transmission.

The committee recommends that the National Institutes of Health give increased priority to research on personal and community health practices relevant to disease transmission. Attention should also be focused on developing more effective ways to use education to enhance the health-promoting behavior of diverse target groups.

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