must be a strong, clear leadership structure in the Department of Health and Human Services.

From these findings, the Committee recommends a new strategy for preventing HIV infections. As a starting point, the nation should adopt an explicit prevention goal: to avert as many new HIV infections as possible with the resources available for HIV prevention. While this may seem an obvious goal, the Committee found that many current HIV prevention efforts are inconsistent with this principle. To reach this goal, a new vision is needed that will improve the way the epidemic is monitored, change how prevention resources are allocated and how activities are prioritized and conducted, foster interactions between the public and private sectors to promote new prevention tools and technologies, and reduce or eliminate social barriers to HIV prevention.

This strategic vision is comprised of six elements:

  • develop an accurate surveillance system, focused on new HIV infections, that can better predict where the epidemic is headed;

  • allocate prevention resources to prevent as many new HIV infections as possible, guided by principles of cost-effectiveness rather than simply by the number of AIDS cases;

  • direct prevention services to HIV-infected persons, who often have been excluded from prevention activities, and integrate prevention activities into the clinical setting in order to reach people at high risk of becoming infected;

  • translate findings from prevention research into action at the community level;

  • invest in the development of new tools and technologies to expand HIV prevention efforts; and

  • strive to overcome social barriers and to remove policy barriers that impede HIV prevention.

DEVELOPING AN ACCURATE SURVEILLANCE SYSTEM FOCUSED ON NEW HIV INFECTIONS

To best plan and evaluate prevention activities and allocate resources for HIV prevention, a national surveillance system is needed that identifies new HIV infections (HIV incidence). The current epidemiological surveillance system—which is based primarily on AIDS case reporting and, more recently, on HIV case reporting in selected states—does not provide a complete or accurate picture of HIV incidence. By focusing mainly on AIDS cases, where diagnosis lags approximately 10 years after HIV infection without treatment and even longer than 10 years with potent new antiretroviral therapies, today’s surveillance system looks at the past



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