Prevention of HIV infection through changes in sexual behavior.

Ample evidence exists that behavioral interventions reduce high risk sexual behaviors and promote safer practices. Downstream interventions in settings attracting high risk patients work well, especially with infected persons to avert new infections. Preparing health care workers for intensive, skills-based interventions grounded in behavioral science theory would enhance primary prevention. Midstream interventions have reliably reduced risk in primary care and community settings. Adoption of comprehensive skills-based programs in schools is controversial but likely to improve outcomes. Upstream community approaches have slowed human immunodeficiency virus (HIV) incidence among men having sex with men. Upstream policy interventions remain underutilized in the U.S. but have been successful internationally. Needed are a national HIV prevention strategy and research linking behavior change to reduced HIV seroprevalence.