Role of state health agencies in responding to AIDS.

State health agencies have assumed a leadership role in responding to the major public health issues raised by the AIDS epidemic. Directors of State health agencies (State health officers) have asserted their influence at the national level as well as at the State level. The Association of State and Territorial Health Officials (ASTHO), and especially ASTHO'S AIDS Committee, has served as the primary vehicle through which State health officers communicate their views to the Federal Government and vice versa. To date, ASTHO has held four national conferences on AIDS. Each one has brought together Federal, State, and local officials, advocacy groups, and other public health experts, and each has resulted in practical recommendations to public health departments on how to implement their AIDS programs most effectively. Although State health agencies have responded differently to the epidemic, many have adopted innovative, and sometimes unpopular, approaches. State health agencies' responses to the AIDS epidemic are governed partly by environmental factors, including the views of political leaders in the State, the strength of concerned advocacy groups, and the number of AIDS cases in the State. Despite their different approaches, State health officers have agreed that education is the most important tool in their programs to prevent human immunodeficiency virus (HIV) infections. The rapidly changing AIDS epidemic has required State health agencies to be flexible in their approaches to controlling the epidemic. State health officers' evolving views about HIV testing and partner notification are two examples of how new information about the epidemic has affected States' HIV control programs.