For years programs aimed at preventing the spread of the AIDS epidemic followed a scattershot approach intended to reach as wide an audience as possible. Now a new study by the National Research Council disputes the conventional wisdom. It argues that AIDS could be wiped out even in the absence of a cure or new drugs by prevention efforts that zero in on 25 to 30 of the most affected neighborhoods in the nation.
The study, entitled "The Social Impact of AIDS," challenges the view that everyone is equally at risk for contracting AIDS. Instead, the council said the epidemic was "settling into spatially and socially isolated groups and possibly becoming endemic in them." As a result, "many geographic areas and strata of the population are virtually untouched by the epidemic and probably never will be," while "certain confined areas and populations have been devastated," the council said.
At the same time, the council noted that recent data suggest it is possible to reverse the course of an AIDS epidemic or even to prevent one if efforts are intense and narrowly focused.
The panel cited Australia and Tacoma, Wash., as areas where the rate of new AIDS infections has been stabilized as a result of aggressive programs targeted at high risk groups such as gay men and intravenous drug users and their sexual partners.
Studies of the pattern of AIDS infection in the U.S. have shown that the disease seems to be concentrated in clusters of neighborhoods in 25 to 30 of the nation's major cities, including New York, Newark, Camden, N.J., San Francisco, Miami and Los Angeles.
The theory is that by focusing resources on these epicenters of the disease, the rate of new HIV infections could be kept at a such relatively low levels that the epidemic eventually would be halted in its tracks.
In Baltimore City, for example, most new AIDS cases are concentrated in a relatively small number of inner-city neighborhoods that are high in rates of poverty, unemployment and other measures of socioeconomic distress.
In recent years, the focus of the epidemic here has shifted from gay men to IV drug abusers and minorities, who now make up 80 percent of new HIV infections locally.
The city health department has already begun targeting these areas with special outreach and education programs. But funds for education, prevention and drug-treatment efforts in the city have been cut repeatedly by the state -- an example of Maryland's penny-wise, pound-foolish approach to the epidemic that is, quite literally, a prescription for disaster.