Healthy People 2010's two overarching goals are to increase quality and years of healthy life and to eliminate health disparities. This focus area identifies objectives to help achieve these goals through reducing the burden of HIV and acquired immunodeficiency syndrome (AIDS) on individuals and communities.

Since 1981, the HIV/AIDS epidemic has presented an unprecedented public health challenge. It has required an integrated approach to address the medical and behavioral science, sociocultural, economic, and political issues involved in preventing and treating this disease.

In the United States, the annual number of new HIV cases peaked in the mid-1980s and then declined, stabilizing in the early 1990s at about 40,000 new HIV infections per year.¹ With the advent of highly active antiretroviral drug therapy in the mid-1990s, significant progress has been made in decreasing illness and death in HIV-infected persons in the United States.² As a result, HIV-infected persons are living longer, healthier lives. Accordingly, the number of HIV-infected persons with a chronic infection continues to increase.³ At the end of 2003, an estimated 1,039,000 to 1,185,000 persons were living with HIV infection in the United States.⁴

Meeting the treatment and prevention needs of this increasingly larger pool of chronically infected persons, especially HIV-positive low-income Americans, has become a priority for public health programs. A second challenge is to develop new and more effective strategies to prevent new infections and to detect undiscovered cases.

The overall goal of the focus area is to prevent HIV infection and its related illness and death. Since the late 1990s, trends in new HIV/AIDS diagnoses have remained consistent. To achieve further decreases in new HIV/AIDS diagnoses, the U.S. Department of Health and Human Services (HHS) announced a new initiative―Advancing HIV Prevention (AHP)―in 2003.⁵ The Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC) are active partners in the implementation of the AHP initiative.⁶

The AHP initiative addresses the fact that one-fourth, or approximately 250,000 individuals of the more than 1 million HIV-infected persons in the United States, have no knowledge of their HIV status and consequently place themselves and others at risk of infection. The primary goal is to reduce HIV transmission. Three recent activities have advanced this initiative:

• Approval of a rapid HIV test.⁷
• Effective drug treatment that can be given early in the course of the infection to allow HIV-infected persons to live longer, healthier lives.
• Effective drug treatment that significantly reduces transmission of HIV from pregnant women to their babies.⁸

One component of this initiative is an effort to make HIV testing a part of routine medical care, including routine medical screening of pregnant women to reduce perinatal transmission. In addition, new models for diagnosing HIV infection outside medical settings are being implemented, and guidance is provided to encourage infected persons and their partners to reduce their high-risk behaviors to prevent new infections.⁶ Through the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act program,⁹ HHS is providing HIV care and treatment to an estimated 531,000 low-income HIV-infected individuals, including pregnant women.¹⁰ One achievement in HIV prevention during the past decade has been the reduction in transmission of HIV from pregnant women to their babies, as indicated by the decline in perinatally acquired AIDS from about 1,000 cases in the early 1990s to 57 cases in 2003.⁵ An AHP strategy is to further reduce perinatal transmission.