funds from being spent to ensure drug users access to sterile drug injection equipment, a highly cost-effective prevention strategy for those who are at high risk of acquiring HIV because they use injectable drugs.

The succeeding sections of this report lay the foundation for the Committee’s strategic vision for HIV prevention. Chapter 2 builds the case for a national surveillance system that identifies new HIV infections. Chapter 3 illustrates the value of allocating resources according to the cost and effectiveness of alternative programs, and it shows why evaluation is key to informing allocation decisions. Chapter 4 emphasizes the value still to be gained from closer integration of prevention into the clinical setting, and Chapter 5 points to the importance of filling the gap between research findings and effective action in the community. The promise of new technologies and the need for continued investment in research are the subject of Chapter 6. Finally, Chapter 7 tackles the underlying social conditions and attitudes that have hampered prevention efforts from the outset of the epidemic and continue to do so today.

Throughout its deliberations, the Committee has been motivated by the conviction that more can be done to prevent HIV infection. Doing better will require a new way of thinking about cost-effectiveness as a guiding principle for HIV prevention. It will require new leadership, accountability, and coordination; the Committee believes that, for HIV prevention efforts to have maximum impact, there must be a strong, clear leadership structure in the Department of Health and Human Services. Doing better will also require directing prevention efforts to those who are HIV-infected and those—women, youth, and racial and ethnic minorities—who are the new faces of the epidemic. It will require more effective translation of HIV prevention interventions that are successful in research settings into activities that are effective in communities. And it will require removing obstacles that impede the implementation of those interventions that we now know to be effective.



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