AIDS prevention in the United States: lessons from the first decade.

AIDS prevention programs in the United States have been relatively successful in providing accurate information on AIDS to a wide cross-section of the population, but less successful in helping people to change their risk behavior. The most significant changes have been reported in urban gay men, with lower levels of change in drug users, and the least change in young adult heterosexuals. Various obstacles to effective AIDS prevention interventions have been identified, including too great an emphasis on information; a reliance on one-way rather than interactive communication; a narrow categorical approach to AIDS; a failure to integrate prevention and treatment services; and unwillingness to acknowledge widespread distrust of government, scientists, and health officials; and a focus on individual behavior rather than the social and political factors that shape behavior. To address these obstacles, AIDS educators should identify and strengthen those cultural forces that support prevention while also challenging those that block it. AIDS prevention programs need to be integrated into other programs serving community needs, especially into those grassroots organizations that can raise questions of gender behavior and drug use. While AIDS organizations should help meet the service needs of people with AIDS, they must also play a role in mobilizing communities to demand the resources they need to contain the further spread of the epidemic. Finally, AIDS prevention programs need to be linked to a vision of a better world in which the conditions that have contributed to the rapid spread of HIV infection are addressed and improved.