In the general population the culture of sexuality is changing. Young people today know it is essential to protect themselves.

Behavior change
Many nations of the Americas have accepted the challenge of AIDS head on. One example already mentioned is Brazil. "What Brazil did serves as a model," says Fauci. "They have excellent vision at the top. The country's political leaders and leaders in health realized very early on that it is important to link prevention with treatment, to provide access to treatment throughout the country, to try and overcome in a creative way the obstacles to the availability of very expensive drugs, making those drugs generic and that way available for people with low incomes. They have shown leadership, creativity and concern. They didn't deny the problem; they faced it."

The 2002 UNAIDS report also cites Brazil's policies on intravenous drug users as exemplary: "Brazil has adopted a less punitive approach to dealing with the dual challenge of injecting drug use and HIV infection—to good effect. Prevention programs among injecting drug users have contributed to a substantial decline in HIV prevalence in this population in several large metropolitan areas. In addition, a national survey has shown increasing condom use among injecting drug users (from 42 percent in 1999 to 65 percent in 2000)—a sign that sustained education and prevention efforts are bearing fruit."

Another key element in slowing the region's epidemic has been organized advocacy by self-described "seropositives." The Latin American Network of People Living with HIV/AIDS coordinates seven regional advocacy networks that work closely with governments, nongovernmental organizations and international agencies fighting AIDS. "Horizontal cooperation has made it possible to win many battles, especially against discrimination and high drug prices," says Javier Hourcade Belloq, regional secretary of the network.

Zacarias notes that "with the new antiretroviral therapies, fewer patients go on to develop AIDS, and the number of hospitalizations in the countries has declined significantly."

Then why not step back and rest a bit? In San Francisco, the epicenter of the epidemic in the 1980s, prevention efforts succeeded in dramatically lowering the incidence of infection among men who have sex with men. In those early years, fear was the driving force. Friends and lovers were dying; people had to be very careful. Yet a recent study by the city's Department of Public Health shows an increase in infections over the last six years.

"The new generations of men who have sex with men do not have the same perception of the danger to them," says Zacarias. "They know there is good medication, that the infection can be treated. But we must keep telling them, it is always, always best not to become infected."

Zacarias and Fauci are veterans in this war, and both are competent to forecast the epidemic's future. Zacarias proffers the following: "This process of stabilization of the epidemic, I might not be around to see it myself, but it can be achieved. In the general population the culture of sexuality is changing. Young people who became sexually active in the AIDS era know it is essential to protect themselves. The key words are care, prevention and treatment."

Fauci says: "We are at a critical point right now. If we are not aggressive in prevention and education and behavior modification, if we don't put the resources there to treat people who are already infected and link treatment with prevention, then it could get much, much worse. But if we do it right, we have the opportunity to have a major impact on the epidemic right now."

Additional Information:
The AIDS lifeline: access to drugs
The search for a vaccine

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