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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

Molly Morgan Jones, a Research Leader in RAND Europe, discusses how antiretroviral (ARV)-based HIV prevention strategies need to be closely tailored to local contexts and cultures in order to make an impact on new HIV infections globally.