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Part Five: HIV Study The global HIV epidemic cont

The global HIV epidemic continues to expand rapidly. In the United States alone, as of December 1993, more than 360,000 persons were reported diagnosed with AIDS. The death toll has been more than 220,000 (National Center for Infectious Diseases, 1993, pp. 1-5). In 1992, HIV infection became the leading cause of death among men ages 25 to 44 and the fourth leading cause of death among women in the same age group. As of 1992, the cumulative costs for treating all persons with HIV infection in the United States were estimated to be $10.3 billion and were expected to increase to approximately $15.2 billion by 1995.

Governmental and nongovernmental organizations, local communities, researchers and advocates, and individual citizens together have responded to the epidemic by designing and implementing numerous programs to help people change behaviors that put them at risk of acquiring or transmitting HIV infection. The ôproblemö to be explored in this research is HIV prevention programs should be evaluated systematically so that program managers and policy makers can make program decisions based on empirical findings rather than subjective impressions, and program utility and quality can be ensured. In 1994, HIV prevention programs underwent a special reexamination. Not only is the role of HIV prevention being discussed within the context of health care reform, but a shift is occurring toward more comprehensive community participation in shared decision making about HIV prevention efforts.

For example, in 1994, the Centers for Disease Control and Prevention (CDC) formally introduced community planning as an essential component of its program support for HIV prevention programs at 65 local, State, and Territorial health department levels. This type of planning requires HIV-AIDS epidemiologic surveillance and other data, ongoing program experience, program evaluations to date, and a comprehensive, objective needs assessment process...

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