Yet when we look at what has actually changed, at what behaviors have
been fundamentally altered, and at what social institutions have been re-
structured as a consequence of AIDS, it is striking how little has been ac-
complished in terms of getting the pandemic under control through effective
prevention programs and of ameliorating the social, cultural, political, and
personal impacts of AIDS. In most of the developing countries where HIV
is already rampant, while sexually active teenagers and adults may be very
worried about getting AIDS, there is usually little or nothing that they are
doing to change their sexual behavior to prevent HIV infection. In those
African cities where one of every four sexually active adults is currently
HIV seropositive, the alarming reality remains that only a tiny minority of
the population uses condoms properly and regularly during sexual inter-
course. The vast majority do not use condoms at all. Few individuals utilize
other forms of safer sex, such as interfemoral sex, to reduce HIV risk. In
those same African cities where funerals for persons who have died of AIDS
have become commonplace, where the managerial sector of key industries
has been especially hard hit by personnel losses due to AIDS, and where
the number of AIDS-related orphaned children continues to climb more
rapidly than the resources of either society or government to cope with the
needs, AIDS is still viewed much as it was a decade ago. It remains a highly
stigmatized disease that few care to talk about in public.

Policy decisions are being made throughout the world on how to best
handle the AIDS crisis. Areas of policy formulation include such issues as
mandatory or voluntary HIV reporting, mandatory or voluntary HIV test-
ing, priorities in AIDS health and social services funding, quarantining and
immigration restrictions, screening blood supplies in developing nations,
effective strategies for HIV prevention, and HIV-related discrimination and
neglect.

In general, politicians and biomedical administrators have set the direc-
tion for global AIDS policy until now. By and large, this policy has failed,
and failed miserably. It is the premise of this book that to effectively ac-
complish the control of HIV on a global scale, it will be necessary to replace
political considerations and a biomedical approach with a public health
and social science approach. Needle exchange programs are a good ex-
ample of the need to reformulate policy. Political considerations in the
United States and elsewhere have prevented needle exchange programs
from being implemented. Conservative politicians and some religious and
African-American leaders have opposed needle exchange programs, assert-
ing that they promote drug use. Those who favor a biomedical approach
have been reluctant to support any program that will facilitate the use of
a harmful narcotic. However, public health and social science research has
demonstrated that such programs reduce HIV seroprevalence in an injecting
drug-using population and do not promote greater drug use.

Vincent E. Gil's chapter ("Behind the Wall of China: AIDS Profile, AIDS

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