fectiousness. It must focus on the behaviors of infected individuals who are
exposing others to the virus and assess carefully the results of interventions
intended to change these behaviors. It must recognize that public policies to
contain the epidemic necessarily will be diverse, varying among different
groups and different individuals, depending on cultural factors and on how
risky or intransigent their behaviors are. The nation must be prepared strongly
to encourage individuals to learn their HIV status and to insist that they take
responsibility for not placing others at risk.

In addition to seeking to identify and modify the behavior of those who
carry the virus, public policies must support individuals who are free of the
virus in remaining so. While helpful, the use of condoms is not adequate to
stem the spread of HIV, any more than it has proven a completely successful
mechanism for birth control. Having sex with an HIV-infected person,
especially if he or she is at any advanced stage of infectiousness, still presents
a high risk of transmission. And repeated encounters only add to that risk. The
only way in which the natural biological dynamics of the disease can be contained
in a society that is not universally monogamous is by limiting sexual encounters
between the infected and the noninfected: The only safe set is sex between
uninfected partners.

By encouraging massive, routine, voluntary testing we can enable society
voluntarily to segregate itself sexually into two groups: those who carry the
virus and those who do not. No other means is likely to alter the course of the
HIV epidemic. In addition to requiring responsibility from carriers, we must
enable those who are free of the virus to learn of the HIV status of their sex
partners and to act on this information. This will require the development of
better, more accurate tests and testing procedures than exist today, followed
by their universal and repeated use throughout society. This goal should be
promoted first by making tests truly routine--free and easily available--and by
establishing strict rules governing their disclosure and use.

Equally as important as this direct assault on the spread of HIP is the pres-
ervation of the democratic, humanitarian values that characterize our nation. No
war on HIV disease can be allowed to degrade the society we are trying to
preserve. In seeking to contain the spread of the HIV epidemic, we cannot
ignore the rights to privacy and personal freedom of those already infected.
Neither can we ignore our responsibility to treat everyone in our society with
compassion and generosity. At the least, this means free or inexpensive testing
and treatment and aggressive defense of the civil and employment rights of
those who carry the virus.

These steps to contain the epidemic are drastic, intensely controversial
policies that initially may be repugnant to many Americans. Some may see
them as harsh, others as unduly liberal. It is only the alternative that makes
them conceivable--allowing hundreds of thousands, or millions, of prevent-

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