Although in the USA, as in many other countries, there have been HIV

The USA

prevention campaigns aimed at the general population, many of the most notable programmes have concentrated on the groups at highest risk of infection. This is regarded as the best approach for a country with relatively low HIV prevalence.

Gay men

A typically explicit poster produced by the San Francisco AIDS Foundation in 2001

The world’s first major HIV prevention campaigns targeted gay and bisexual men in US cities. They began around 1984 and were run by non-governmental organisations such as the San Francisco AIDS Foundation, AIDS Project Los Angeles and Gay Men’s Health Crisis in New York. These community-based groups had for some time been teaching people about AIDS and how it was most likely acquired, but they found that this was not enough. Even men who saw friends suffer and die of AIDS found it difficult to make long-term lifestyle changes.

The pioneering AIDS organisations found that the most effective approach was to provide men with explicit information and skills training in how to practise safer sex, and how to negotiate safer sexual relationships. This type of programme proved very popular and helped many thousands of men, initially with little support from the federal government. Largely because of this community-led response, levels of high-risk sexual behaviour plummeted among urban gay communities in the mid- to late 1980s, and the rate of new HIV infections fell substantially.^{1 2}

Recent studies in the US (as well as other Western countries) have found that levels of high risk sex between men who have sex with men have started rising again. This may be partly because new HIV & AIDS drugs have made HIV less frightening.³ There is therefore a real need for more prevention projects targeting this group. It should also be noted that the decline in HIV has been much smaller among black and Hispanic men than among white men.⁴