HIV/AIDS, especially in large metropolitan areas. Many participants also noted the importance of maintaining representation on planning groups by people living with HIV/AIDS and by people whose lives are significantly but indirectly affected by HIV/AIDS, such as the family members of infected individuals.
In trying to keep funding for prevention abreast of changes in the epidemic, many participants noted that major challenges remain in serving men who have sex with men, as well as injection drug users. Men from racial and ethnic minority groups, including gay men, bisexual men, and men who do not identify themselves with either of these groups, are of particular concern, as they now comprise a majority of the HIV/AIDS cases among men who have sex with men. Some participants said that heterosexual women, particularly women from racial and ethnic minority groups, who now represent the largest proportion of women impacted by HIV/AIDS, are in need of increased attention as well. In this regard, participants called for more research to be devoted to developing prevention methods that women themselves can control, such as microbicides. Increased prevention efforts also should be targeted at young people, many of whom are sexually active and, because they came of age after the first flourish of HIV/AIDS prevention activities, may not have gained adequate knowledge of risk behaviors and methods to reduce those risks.
In addition, participants noted that as new treatments are becoming available, more people are living with HIV/AIDS, and thus it is becoming increasingly important to target interventions to reach HIV-infected individuals. In some communities, the participants reported, growing numbers of infected individuals apparently are resuming high risk behaviors that hold potential for spreading the epidemic. Advances in treatment are having another effect as well, according to some participants, who noted their worry that more and more policymakers, from the federal to the local level, seem to be shifting both their concern and their budget priorities, away from prevention and toward treatment-only programs.
There was some disagreement about whether prevention interventions being used today are indeed based on the latest scientific evidence. Federal officials generally maintained that the majority of prevention programs being implemented incorporate methods that many observers view as effective. Some representatives of state agencies and private groups, however, suggested that in some communities, both the planning process and intervention efforts are often “more gut-based than evidence-based,” as one participant said. All participants agreed that more attention should be directed at program evaluation in order to document—in a variety of communities, using a variety of interventions, and focusing on a variety of at-risk populations—which prevention methods work best under particular conditions. In this regard, some participants pointed out the need