"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 panel.

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 injecting equipment.

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 men.

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 successful.

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/.