Valdiserri Ronald O
U.S. Department of Health and Human Services, Washington, DC 20201, USA.
AIDS Educ Prev. 2011 Dec;23(6):479-94. doi: 10.1521/aeap.2011.23.6.479.
The year 2011 marks the thirtieth anniversary of the first case reports in the United States of what we now know to be end-stage HIV disease. This chronological milestone provides an opportunity to reflect upon the changing context of the American HIV/AIDS epidemic. Using two seminal documents as a framework, the 1986 Institute of Medicine Report, "Confronting AIDS," and the 2010 National HIV/AIDS Strategy, this descriptive analysis details our accomplishments in addressing the domestic U.S. epidemic and outlines what remains to be done on the long road to eradication of HIV disease. The past three decades have witnessed tremendous biomedical and behavioral advances in preventing, diagnosing, and treating HIV disease. However, to fully realize the promise of these scientific advances, such that we achieve the vision of the National HIV/AIDS Strategy, we must develop effective strategies to surmount a number of salient challenges, including: unbalanced combinations of prevention interventions; programs that are not of adequate scale to achieve population-level results; systems of service delivery that do not function in an integrated fashion; and social and economic structures that increase the vulnerability of populations who are at risk for or living with HIV disease.
2011年是美国首次报告如今我们所知的晚期艾滋病病例30周年。这一按时间顺序排列的里程碑事件为反思美国艾滋病疫情不断变化的背景提供了契机。本描述性分析以两份具有开创性的文件为框架，即1986年医学研究所的报告《正视艾滋病》和2010年的《国家艾滋病战略》，详细阐述了我们在应对美国国内艾滋病疫情方面取得的成就，并概述了在根除艾滋病这一漫长道路上仍有待完成的任务。在过去三十年里，在预防、诊断和治疗艾滋病方面取得了巨大的生物医学和行为学进展。然而，为了充分实现这些科学进展的前景，以便我们实现《国家艾滋病战略》的愿景，我们必须制定有效的战略来克服一些突出的挑战，包括：预防干预措施组合不均衡；规模不足以取得人群层面效果的项目；未以综合方式运作的服务提供系统；以及增加感染艾滋病风险人群或艾滋病患者脆弱性的社会和经济结构。
