Global AIDS: critical issues for prevention in the 1990s.

A review of the first decade of global experience with the struggle against HIV/AIDS suggests that prevention will require both full application of existing approaches and fundamental changes in concepts and values. The critical deeper issues can be grouped under three headings: behavior, societal action, and globalism. Behavior, individual and collective, will be increasingly recognized as the major challenge for public health. However, for purposes of HIV prevention (and other issues) a sufficient understanding of behavior has not yet been developed. At the societal level, the activism of community organizations has shifted the balance of initiative in public health toward the community. The long-term implications of this evolution for roles and responsibilities at the community, national, and international levels must be explored. Finally, an understanding of global solidarity, based on respect for human rights and on the objective conditions of the modern world, will be critical for the future capability to deal effectively with HIV/AIDS. In summary, the future of HIV/AIDS prevention and control cannot be separated from the major public health and social issues of our time.