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March 2002, Vol 92, No. 3 | American Journal of Public Health 332-333
© 2002 American Public Health Association

LETTER

JANSSEN ET AL. RESPOND

Robert S. Janssen, MD, Ronald O. Valdiserri, MD, MPH, Melissa Shepherd, BA and Kevin De Cock, MD, FRCP, DTM&H

The authors are with the National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga.

Correspondence: Requests for reprints should be sent to Robert S. Janssen, MD, Division of HIV/AIDS Prevention, 1600 Clifton Rd, Mail Stop D-21, Atlanta, GA 30333 (e-mail: rxj1{at}cdc.gov).

We appreciate the support expressed by the letters in response to our article on the Serostatus Approach to Fighting the HIV Epidemic (SAFE), which discusses expansion of prevention programs to include the prevention needs of HIV-infected individuals. We agree that certain concerns must be addressed to successfully implement this strategy.

An important aspect of SAFE is targeting the prevention needs of those who are infected and of those at highest risk for infection. It is clear from 20 years of surveillance data in the United States that not all groups of people in the country are at equal risk for HIV infection. Resources for prevention have always been limited, and efficient use of resources, including targeting those at greatest need, is critical to successfully addressing the epidemic.

We also agree that focusing programs on infected individuals has the potential to lead to further stigma, and thus we advocate programs that not only support individuals who learn that they are infected but also link such individuals to comprehensive social services, including services that can reduce the risks of violence. In addition, it is critical that programs be linked to care and treatment for HIV, substance abuse, and mental health problems. It will also be necessary to ensure that laws adequately prohibit discrimination against those who are HIV positive. Nevertheless, with the cautions expressed by Mills in mind, the way of the future will undoubtedly call for more voluntary HIV testing and interventions for the infected. We agree that "mainstreaming" HIV is essential to normalize HIV and reduce stigma.

We have emphasized the need for voluntary HIV testing. In fact, in late 2001 the Centers for Disease Control and Prevention released new guidelines for HIV counseling, testing, and referral that continue to emphasize the need for voluntary HIV testing and continued support for anonymous testing. In other countries, political support from the highest levels of government will be critical in supporting increased noncoercive testing.





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