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http://www.nytimes.com/2002/08/13/health/13AIDS.html

New Tactic to Prevent AIDS Spread

By DAVID TULLER

he idea that people with H.I.V. should take steps to prevent passing along the infection may seem self-evident. But health officials have long understood that a host of factors — stress, a craving for intimacy, fear of rejection, drug and alcohol abuse — can cause lapses in judgment and self-restraint that lead people to have unsafe sex.

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So AIDS educators, alarmed at the continuing spread of H.I.V., have now added a crucial weapon to their prevention arsenal: educational campaigns encouraging infected people to take responsibility for not transmitting the virus.

The move represents an acknowledgment that the traditional prevention approach to AIDS — teaching people how to protect themselves from infection in the first place — has lost some of its effectiveness. Better treatments have improved the health and extended the active sex lives of people with H.I.V. and have also made many others less fearful of contracting the virus, researchers say.

"Of course people want to be responsible," said Chris Wittke, H.I.V. prevention manager at the AIDS Action Committee of Massachusetts, which has sponsored an advertising campaign focused on H.I.V.-positive men. "But that's an intellectual argument that doesn't take into account the factors that go into how people have sex and relationships, like love, lust, heat, desire and need."

The Centers for Disease Control and Prevention, which estimates that 900,000 people in the United States now have H.I.V., hopes to reduce the number of new infections to 20,000 a year by 2006, from 40,000. As part of that effort, the agency is spending $3.8 million a year for "prevention for positives" programs in California, Maryland and Wisconsin. Other states and cities have started such programs on their own.

The "prevention for positives" efforts cover a variety of activities. In San Francisco, the Stop AIDS Project, a community-based advocacy group, is sponsoring discussion groups for gay men with H.I.V. that specifically address ways to sustain safe sex practices. In Modesto, Calif., health educators are trying to help physicians improve their skills in discussing risk reduction with their H.I.V.-positive patients.

One high-profile effort is an advertising and Internet campaign called "H.I.V. Stops With Me," which began in San Francisco two years ago and has been expanded to several other cities, including Los Angeles and Boston. It features people with H.I.V. who appear on television commercials and billboards, tell their stories on the campaign's Web site (www.hivstopswithme.org) and respond to e-mail messages.

The representatives sometimes discuss their struggles in highly personal terms.

"The risks I took and the positions I put myself in with random strangers in dark, sometimes unsafe places, is enough to make my skin crawl," wrote Troix, a 27-year-old veterinary assistant in Boston. "I was lonely, hurting and too wrapped up in my own drama to step outside of myself and remember what it was like for me to get back that positive result."

The new educational efforts have not pleased everyone. Billy Curtis, a San Francisco youth counselor, said he was horrified when he first saw the "H.I.V. Stops With Me" advertisements because he thought they made scapegoats of people with the virus and absolved the uninfected of having to think about protecting themselves.

"You're saying to people you have irresponsible H.I.V.-positive people infecting these innocent H.I.V.-negative people," said Mr. Curtis, who is gay. "But ultimately I am responsible for whether I seroconvert or not."

But supporters of the campaign say that a vast majority of prevention efforts still focus on those who are not infected, and that the intent is not to pass judgment but to offer emotional support to people with H.I.V.

Bob Lawrence, a Modesto gay man with H.I.V. who serves on a committee that advises county officials on prevention of the disease, said that at first he also opposed the idea of directing campaigns at infected people. But after hearing more about the concept, he changed his mind. Part of the message the county needs to convey, he said, is that H.I.V.-positive men who have unsafe sex are not only endangering others but are at greater risk for contracting other sexually transmitted diseases and, possibly, drug-resistant strains of H.I.V.

"I was around back in the days when gay men were told we deserved AIDS because we were an abomination, so my initial reaction was that this was like saying gay men have to stop having sex," he said.

"But then I started looking at this as a way of helping H.I.V.-positive people make healthy decisions."

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