Newsmaker: Dr. Judith Auerbach, Prevention Science Coordinator, and Behavioral and Social Science Coordinator Office of AIDS Research, National Institutes of Health, Discusses HIV Prevention

GEORGE STRAIT: So, does prevention work?

DR. JUDITH AUERBACH: Yes and no. Mostly yes, probably better than people recognize. You know, we talk about the paradox of prevention-that you can't actually see what you prevented-so it's very hard to demonstrate to the world and to actually know how many infections, for example, we have prevented with the devices and strategies we currently have.

We have, obviously, things related to drug use and either reducing the harm of drug use or actually eliminating drug use through either safer injecting practices, providing programs that allow people to exchange needles so that they don't use unclean needles; but, also providing drug treatment for addicts, people who are addicted, has become a very effective strategy for HIV prevention, partly because it reduces risky drug use and sexual behavior, attendant with HIV transmission, but also because it's a place where you can deal with some of the larger issues that underlie both addiction and risk.

What that kind of intervention, loveLife and empowerment Project, and others like it, are trying to do is to take the whole person and say, "You are not just a vector for a virus, but you're a person who might become vulnerable to that virus, or might become vulnerable because you exist in a certain environment, and that environment includes your class, your race, your familial situation, all the things that themselves also affect your psychological well being and your physical and mental health." So, I think addressing those larger contextual issues has become something more and more people recognize as important when you're dealing with HIV infection.

There's a great deal of stigma about homosexuality and bisexuality, which we don't talk about well or positively in ways that might make a difference. And there's a huge stigma against drug use, which, for the most part, is an illegal, if not just an illicit activity. So, I think the kinds of social and political limitations that we all are familiar with about our abilities to converse about things, much less treat people well who relate to those things, are some of our biggest obstacles. I think our big dilemma now is sustaining the prevention successes, because most of the prevention activities that we have that are successful require behavioral choices and changes that are very difficult to ask people to do for a lifetime.

Special coverage from the XIV International AIDS Conference provided by kaisernetwork.org, a free service of the Kaiser Family Foundation.