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Despite major progress against HIV, 21% of HIV+ people in the US are unaware that they are positive and an estimated 33% of those who know they are HIV+ are not engaged in care and treatment for their infection.Another 38% of newly diagnosed HIV+ individuals test so late that they receive an AIDS diagnosis at the same time as, or within one year of, learning they are positive. There were an estimated 56,300 new HIV infections per year between 1996 and 2006. Clearly, the US can and must do better in responding to the HIV/AIDS epidemic. One way to increase the percentage of HIV+ people engaged in care and treatment for their infection and improve their health outcomes is to focus on coordinating or co-locating HIV testing, care and treatment, social services and prevention programs. Increasing the percentage of HIV+ people who know their serostatus and are receiving care and antiretroviral treatment could also have benefits for HIV prevention. The National HIV/AIDS Strategy places testing and linkage to care, treatment and support services at the heart of the effort to improve the health outcomes of HIV+ individuals and prevent new infections. What is the scientific basis for this approach, how might it actually be implemented, and will it have the desired results in the real world?

In June 1996, the Center for AIDS Prevention Studies published the second occasional paper in this monograph series, entitled Sustaining Support for Domestic HIV Vaccine Research: Social Issues Over the Long Haul of Human Trials. Authored by Chris Collins, the research was supported by grants from the National Institute of Mental Health, National Institutes of Health and the University of California, San Francisco. This new report is intended to function as an update to the 1996 monograph. Most of the social and ethical issues discussed in the original paper have not changed during the past two years. Therefore, you will find many of the previously identified challenges and stages of vaccine research and development, concerns about the design of HIV vaccine efficacy trials, goals of community education, potential benefits and harms for impacted communities, and levels of industry involvement, among others, retained. As a progress report on the state of HIV vaccine research, this paper attempts to highlight, generally, both the progress and lack of progress toward the primary recommendations laid out in the earlier paper. By focusing, up front, on the latest activities of government, affected communities, and industry, a clearer landscape of the state of HIV vaccine efforts comes into view; gaps in certain areas point to the work which remains to be done.

Project Access is a qualitative study of barriers to HIV counseling and testing, and the personal HIV prevention strategies of drug users. Main Findings:

• Drug users’ risk behavior was not directly related to the number of times they had previously tested for HIV.
• Personal prevention strategies and HIV testing patterns are shaped by public health messages, institutional practices, and the concrete realities of living and surviving in impoverished communities.
• Many low-income drug users approach HIV as a chronic illness, one of many life threatening diseases facing their communities. HIV infection was seen as random and unpredictable, the virus was believed to lay dormant and completely undetectable within the body for years, and routine screening (HIV testing) was believed to be a primary means of managing HIV.
• Race, class, and gender inflect individuals’ perceptions, their responses to the threat of HIV, and their motivations for HIV testing.
• Health and social service referrals can play an important role in linking these populations to needed services.

CAPS and ETR Associates researchers developed a curriculum to assist sixth, seventh and eighth grade students in postponing sexual activity and using protection if they are sexually active. The curriculum has many characteristics that are shared by successful HIV prevention and sex education curricula.

• Curricula available through ETR Associates for purchase