The AIDS epidemic, although first recognized only 20 years ago, has had a profound impact in communities throughout the United States. By mid-2000, more than 750,000 Americans with AIDS had been reported and more than 430,000 Americans had died.1 After peaking in the mid-1980s, HIV incidence in the United States stabilized in the late 1980s and early 1990s.2 The Centers for Disease Control and Prevention (CDC) estimates that the number of new infections has remained stable at approximately 40,000 per year since 1992.3 An estimated 800,000 to 900,000 Americans were infected with HIV at the end of 1998; of these, as many as 300,000 were unaware of their infection status.3
Additional approaches are required to break the grip of HIV in the United States. With as many as 5 million people at behavioral risk for HIV through unsafe sex and drug use,4 HIV prevention programs have historically been based on behavioral risk factors and demographic characteristics such as race/ethnicity, sex, and age. Activities have been tailored to meet the needs of specific groups without regard to serostatus. Although secondary prevention efforts to reduce associated morbidity and mortality are naturally focused on individuals with HIV, specific primary prevention efforts to reduce transmission from HIV-infected individuals to the uninfected have been limited. The CDC is currently expanding prevention programs to include new and enhanced activities based on HIV serostatus, particularly targeting individuals with HIV, as a way to break the current steady state of HIV transmission.