Prevention of HIV infection in Puerto Rico: A brief historical overview
Cunningham, I.; Vélez Galván, M.L.; Ramírez de Arellano, A.B.; Cunningham, E.L.
Boletin de la Asociacion Medica de Puerto Rico 91(1-6): 29-36
1999
ISSN/ISBN: 0004-4849 Document Number: 703018
While many inroads have been made regarding HIV prevention, much more needs to be done. The number of reported AIDS cases is decreasing but HIV seropositivity remains high, and persons continue to infect themselves. It has been announced that vaccine trials are to begin on the Island, but many informed persons (51,52) have indicated that it will take years for an effective and inexpensive vaccine to reach the market. Behavioral change thus continues to be the most practical way to prevent HIV infection, and should continue to be the focus of most prevention programs. As with other health-related problems, HIV infection is the product of many factors operating at multiple levels. Much effort has been directed toward individual prevention, and many characteristics of individuals have been studied in their relationship with HIV risk. However, both sexual behavior and needle sharing among IVDUs are activities usually carried out by two persons. Therefore more research should be done on dyads, to see if factors of the dyadic relationship are related to HIV risk, and if they can be modified. More work also needs to be done at the community level. Too many persons still believe that HIV infection cannot affect them. Were well-known and respected individuals to speak out publicly on protection against HIV, and why clear communication, self-esteem and self-efficacy are important, the fight against AIDS would gather strength. It is also necessary that professionals and leaders state that all persons who engage in risky sex or IVDU behaviors can contract HIV. One population at risk for HIV infection, and which has not been focused upon for preventive interventions, is the Puerto Rican prison population. We do know that HIV risk practices exist in prisons. Furthermore, the prison population is constantly shifting, in which many offenders enter and reenter both prison and their own communities. We need to better understand the multiple factors that operate with regard to prisoners, so that effective interventions can be created at this complex level. All personnel working in the health care field can be of great value in the fight against AIDS. It is important that those in health care upon whom the public depends be able to put aside all prejudices and be willing to talk and listen to those in need of prevention, explaining all options open to those who request information. In this an informed public can also be of help, in that the public can lobby the government for policies which aid in HIV/AIDS education and prevention. The AIDS epidemic is by no means over. Even if the infection were no longer at epidemic levels, it would still require preventive efforts. However promising the new treatment options, they are far too costly, uncertain, and complicated to represent a viable public health solution. Moreover, they may tend to lull us prematurely into thinking that the worst is now over. The human, economic and societal costs of AIDS continue to rise, and they should make us work harder to determine how, as a society, we can bring about changes to further protection against infection. For that, each and every person in our different occupations is needed.
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