Applying Public Health Principles to the HIV Epidemic

Most HIV infections are spread by persons who do not know that they are infected. This article argues that it is time to adopt the proven strategies that have contained other epidemics: widespread voluntary screening, improved notification of the partners of infected persons, and case management with close monitoring. In the United States, this approach might have the potential to prevent at least half of all cases of HIV infection each year. This article argues that it is time to adopt the proven strategies that have contained other epidemics: widespread voluntary screening, improved notification of the partners of infected persons, and case management with close monitoring. Although human immunodeficiency virus (HIV) infection has killed more than half a million people in the United States, a comprehensive public health approach that has stopped other epidemics has not been used to address this one. When HIV infection first emerged among stigmatized populations (homosexual men, injection-drug users, and immigrants from developing countries), the discriminatory responses ranged from descriptions of AIDS as “retribution” to violence and proposals for quarantine, universal mandatory testing, and even tattooing of infected persons. This response led to HIV exceptionalism, an approach that advocated both for special resources and increased funding and against the application of . . .