monitoring of STD and HIV prevalence and incidence among selected populations is essential both for assessment of the impact of these programs and for decision making on program design and implementation.

Recommendation 3-1. More emphasis must be placed on HIV incidence studies for monitoring trends in HIV infection rates.

Although seroprevalence provides important information regarding currently infected individuals in an area, measuring incidence is also critically important for estimating the rate of change in the spread of HIV infection in a given population. In particular, data on current incidence provide the most direct and immediate information regarding the potential effects of a given intervention. Together, prevalence and incidence studies can provide information regarding the current status of the epidemic in terms of numbers of infected individuals and the rate of spread within a given population on an annual basis.

Recommendation 3-2. STD and HIV prevalence and incidence data should be combined with behavioral and demographic information.

Current surveillance systems are often limited, incomplete, and inconsistent, and they rarely measure behavioral or demographic variables. Given new, noninvasive techniques for the collection and analysis of biological specimens (including blood, urine, vaginal secretions, and saliva), accurate assessment of STD and HIV prevalence and incidence can readily be combined with behavioral and demographic information.

In conjunction with periodic serosurveys, demographic information is needed to elucidate the differential spread of STD and HIV infection in rural and urban settings and variations in seroprevalence and incidence by gender, educational level, profession, income level, age, and other demographic factors. This type of information is critical for targeting prevention messages to selected groups at risk of acquiring and transmitting HIV and for projecting the effects of HIV and other STDs on a population over time.

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