"AIDS is a preventable disease, and the behavior placing the public
health at greatest risk may be occurring in legislative and other decisionmaking
bodies," said consensus panel chairman David Reiss, M.D., professor
and director of psychiatric research at George Washington University Medical
Center in Washington, D.C. "Community and policy level changes made
through government leadership in severely AIDS-stricken countries like Uganda
and Thailand have set model examples of how government leaders can coordinate
interventions that effectively reduce the numbers of new cases of HIV infection.
It's not too late for the political leadership of the United States to follow
their example. Policy and legislative change can have rapid, powerful, and
positive results, including the potential to save significant health care
dollars," Dr. Reiss said, echoing the sentiments of the entire 12-member
Following an extensive review of the scientific literature including covering
hundreds of studies, scientific presentations by 15 research experts, and
public testimony during a 3-day Consensus Development Conference on Interventions
to Prevent HIV Risk Behaviors, the panel determined that the evidence is
clear that behavioral intervention programs such as needle exchange (which
provides sterile needles to drug users so they do not have to share or reuse
them), drug abuse treatment, and youth education on safer sex, while controversial
politically, are indeed successful scientifically. "Policy should be
based, whenever possible, on science, but so often it's not, and that places
the public health in great jeopardy," Dr. Reiss said, addressing the
panel's concern that existing barriers have limited widespread adoption
of these intervention programs.
The panel reviewed studies on the effectiveness of needle exchange programs
and concluded that such an intervention does not increase needle injecting
behavior among current drug users, does not increase the number of drug
users, and does not increase the amount of discarded drug paraphernalia.
The panel strongly recommended the lifting of government restrictions on
needle exchange programs and the legalization of pharmacy sales of sterile
Drug treatment programs that employ methadone maintenance, outpatient drug-free
treatments, residential treatment, or detoxification not only decrease drug
use, but also substantially reduce the frequency of using shared needles
among drug users. The panel criticized the downward trend of Federal funding
of drug treatment programs and urged that this course be reversed.
The panel also concluded that education efforts that focus on safer sex
practices rather than abstinence-only programs are effective in reducing
risky sexual behavior in adolescent and adult populations and that current
laws should be changed to allow Federal funding for such programs.
One in 250 people in the United States is infected with HIV, and every year
an additional 40,000 to 80,000 Americans become infected with the AIDS virus,
mostly through behaviors that are preventable. AIDS is the leading cause
of death among men and women between the ages of 25 and 44. In the United
States, unsafe sexual behavior among men who have sex with men and unsafe
injection practices among drug users still account for the largest number
of cases of HIV infection. However, the rate of increase is greater for women than men,
and there have been larger increases in heterosexual HIV transmission than among men who have sex with
In their full consensus statement,
the panel said that just as the Food and Drug Administration
conditionally approves experimental drugs in emergency situations, the urgency
of the AIDS epidemic justifies the need for implementing those behavioral
intervention programs proven by rigorous scientific study to be the most
The NIH Consensus Development Program was established in 1977 as a mechanism
to resolve in an unbiased, impartial manner controversial topics in medicine
and public health. In the past 20 years, NIH has conducted more than 120
such conferences addressing a wide range of controversial medical issues
important to health care providers, patients, and the general public. NIH
holds an average of six consensus conferences each year.
This conference was sponsored by the NIH Office of Medical Applications
of Research and the National Institute of Mental Health. The conference
was cosponsored by the National Institute of Child Health and Human Development,
the National Institute of Allergy and Infectious Diseases, the National
Institute on Alcohol Abuse and Alcoholism, the National Institute on Aging,
the National Institute on Drug Abuse, the National Institute of Nursing
Research, the Office of AIDS Research, and the Office of Research on Women's
Health, all of NIH; the Centers for Disease Control and Prevention; and
the Health Resources and Services Administration.
The next NIH Consensus Development Conference will be held March 24-26,
1997 on Management of Hepatitis C.
The full NIH Consensus Statement on Interventions to Prevent HIV Risk Behaviors is available by calling toll free 1-888-NIH-CONSENSUS (1-888-644-2667) or by visiting the NIH Consensus Program web site at http://consensus.nih.gov/.