First, let us focus on the main contributions of each author. This will lead us to some general summations about what we have learned concerning the malfunctioning of our society, including our methods of scientific research and public health policy and the barriers to development of effective acquired immunodeficiency syndrome (AIDS) prevention and service programs. To end on a note of hope, drawing on the recurrent features of each chapter, a model is provided for research and organization that are community based, and suggestions are made for how to minimize the constraints within the existing social system. Transformations are rarely instantaneous but involve a continuous, ongoing process. Transformations in life-styles and behavior require constant reinforcement.
Johannes Van Vugt's chapter points out the importance of acknowledging the limits of community based organizations. Epidemiological evidence discussed in the report of the National Research Council's committee on AIDS Research and the Behavioral, Social and Statistical Sciences indicates that homosexual men from the African American and Hispanic communities and "in small cities and rural areas, and those who are in their teens and early 20's, appear never to have received the 'safe sex' message" ( Wheeler 1990, A6-A8). Even among gay white men over 30 who "generally appear to have adopted 'safe sex' practices that have slowed the spread of the virus, some signs are evident of a 'relapse' to unsafe practice." As one of the report's authors, Thomas Coates of the Center for AIDS Prevention Studies, University of California, San Francisco, reported, "The opportunity for continued spread among gay men is clearly there." This indicates, as the committee urged, that new educational campaigns be designed ( Wheeler 1990, A6).
The success of community based organizations must be built upon and not left to lie. Behavioral change is in need of reinforcement and follow-up programs, like that of Gay Men's Health Crisis (GMHC) "Eroticizing Safe