HIV Prevention in Industrialized Countries KIM RIVERS and PETER AGGLETON INTRODUCTION 13 Acquired immunodeficiency syndrome (AIDS) was first diagnosed in the United States in the early 1980s, and since that time every country in the world has reported cases. In the short term, the prospect of a preventive vaccine is not encouraging. l New therapeutic agents have offered some people with human immunodeficiency virus (HIV) a substantially improved quality of life and the possibility of a near-normal life span. 2 However, the consequences of mv /AIDS continue to be very serious even in countries where there are resources to pay for new treatments. A combination of social and behavioral change therefore remains essential in reducing the risk of HIV infection.2,3 Over the last 15 years, a great deal has been learned about the kinds of programs and interventions that are most effective in preventing mv infection. In this chapter, we will describe and review some of the major HIV prevention initiatives that have taken place in Australia, Canada, New Zealand, and selected countries in Western Europe. The Impact of HIV Infection in Industrialized Countries Groups most affected by mv and AIDS in industrialized countries include those already widely discriminated against and marginalized in society, such as gay men and injecting drug users. The consequences of mY/AIDS have been felt not only by individuals, families, and communities, but by the health system, education and other public sectors, and the economy. People affected by AIDS routinely have experienced ignorance, stigmatization, and ostraciza- tion, which may lead to feelings of isolation and sometimes shame. 4 ,5 Not surprisingly, disclosure of mv status constitutes another major source of stress for HIV-positive people. 6 Persons affected by HIV/AIDS report concerns about their continuing health, future welfare, longevity, and ability to earn a living.4 People with mv additionally often face the stress of caring for other people who are ill. 4 Individuals, families, and networks of friends affected by mv are not infrequently denied the support usually available to people who have another life-threatening diseases. 5 Women with mv /AIDS in particular, who traditionally are expected to be carers and nurturers, may face the additional worry of caring for others. 6 In Australia, for example, some women with HIV/ KIM RIVERS and PETER AGGLETON • Thomas Coram Research Unit, Institute of Education, University of London, London, WCIH OAA England. Handbook of HIV Prevention, edited by Peterson and DiClemente. Kluwer Academic/Plenum Publishers, New York, 2000. 245