摘要：The Centers for Disease Control and Prevention has undertaken an advisory process to update its national HIV prevention plan. We offer observations on the magnitude of HIV prevention challenges in the United States and reflect on how these challenges might influence the structure of a new HIV prevention plan. We recommend a plan structure that (1) is based on fundamental principles of prevention, (2) enables accountability and mid-course correction, and (3) if achieved, would result in historic changes in the US HIV epidemic. The recommended plan structure would differentially prioritize serostatus determination and prevention and care interventions for people living with HIV while retaining goals directed at high-risk HIV-negative and general population members. IN JANUARY 2001, THE Centers for Disease Control and Prevention (CDC) issued a national HIV prevention strategic plan. It called for a reduction from 40 000 new HIV infections per year in the United States to 20 000 in 2005 with an emphasis on reducing racial/ethnic disparities in infection rates. 1 The plan had 4 major domestic subgoals, dozens of strategies, and hundreds of action steps. The goal of a 50% reduction in incidence was not achieved; in fact, between 2001 and 2005, little progress was made in lowering the number of new infections, and racial/ethnic disparities continue. 2 , 3 The CDC has embarked on a consultation process designed to gain input to help update the national plan. The CDC/Health Resources and Services Administration Advisory Committee on HIV and STD Prevention and Treatment is providing input to and working collaboratively with the CDC on this planning process. The move to update the plan coincides with the release of a report by the Presidential Advisory Council on HIV/AIDS 4 and the new HIV prevention initiative focusing on HIV testing included in the president’s budget proposal for fiscal year 2007. 5 We discuss the magnitude of HIV prevention challenges in the United States and reflect on how these challenges should influence the structure of the new HIV prevention plan. The plan structure we suggest is based on 3 fundamental tenets : (1) sound principles of prevention, (2) accountability and midcourse correction, and (3) goals that, if achieved, would result in historic changes in the US HIV epidemic. Further, the plan would comprehensively include the following services: (1) serostatus determination, (2) prevention and care for persons living with HIV, (3) prevention for high-risk HIV-negative persons, and (4) programs for the general population designed to increase HIV-related knowledge and reduce stigma toward persons living with HIV. Additionally, it would explicitly address the full range of federal health policy and funding authority (not just CDC policy and funding).
