that use HIV seroconversion as an outcome probably cannot be expected to find absolute or complete reductions in HIV seroincidence. Programs that are more comprehensive in orientation and that include components on the prevention of sexual transmission would seem to have greater impact in terms of HIV prevention. However, it must be kept in mind that injection drug users are at risk for a wide variety of blood-borne pathogens, including the hepatitis viruses. Strategies to prevent transmission of the HIV infection by injecting drugs in this population might have broader public health impact in terms of prevention of other blood-borne pathogens as well. In evaluating HIV prevention programs, it is important to consider whenever possible their impact on other infectious diseases.

Finally, in order to assess the needs of a community, better methods of monitoring epidemic spread and the potential for such spread must be developed. Consequently, the panel supports the creation of more active epidemiologic surveillance of HIV prevalence and incidence so that the current progress of the epidemic can be accurately monitored. We also strongly encourage development of surveillance for behavioral data on known risk behaviors (i.e., sexual behavior and drug use), as well as surrogate markers for HIV risk, such as incident sexually transmitted diseases. This is needed so that intervention programs can be appropriately selected and evaluated.

The panel's review of the available epidemiologic data lead to the following specific conclusions and recommendations.

Conclusions
  • The spread of HIV among injection drug users, their sexual partners, and offspring accounts for a major proportion of new HIV infections in the United States, and the resultant propagation of the AIDS epidemic.

  • Throughout the United States, the epidemiology of HIV and AIDS differs, depending on geography, inherent differences in the population at risk, and the distribution of risk behaviors associated with transmission.

  • Injection drug use with contaminated injecting equipment contributes significantly to the spread of HIV infection and thereby to the AIDS epidemic.

Recommendations

The panel recommends that:

  • The Assistant Secretary for Health should charge appropriate agencies to develop improved ways of monitoring and reporting the prevalence



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