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Dawning answers: how the HIV/AIDS epidemic has helped to strengthen public health
  1. E Smith

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    Ronald O Valdiserri, editor. (Pp 209; £29.92). Oxford University Press, 2003. ISBN 0-19-514740-5

    The HIV epidemic is still a great threat to public health, and the complexity of the infection regarding both biological and social aspects has challenged our skills to prevent its spread. The book presents a historical analysis to inform current policy development and to forecast the future, and describes some very important lessons learned during more than two decades with the HIV epidemic.

    HIV has influenced the development and understanding of the use of multiple surveillance methods, integrated case based and behavioural surveillance, active collaboration between different public health stakeholders, and confidentiality and anonymity have become important issues.

    Although sex may well be the most pleasurable human activity it is also very tabooed. The HIV risk reduction thus entails difficult behaviour changes, and the involvement of community members in this public health activity has become crucial. The adoption of “grey area” behaviours among at risk populations has led to the need for structural and individual level intervention. The HIV epidemic has shown the necessity of understanding surveillance data in their social context, for example, sex for drug. At the same time the “All or nothing” thinking opened to the principle of harm reduction.

    The HIV epidemic has shown the importance of translating research results into active intervention and routine service delivery. HIV has had an impact on the organisation of prevention and care services and the public health planners are urged to consider the entire healthcare system, using all data available. Legal aspects and ethical issues, such as human rights, especially in relation to testing policy, named reporting and partner notification are very well discussed in the book.

    The nine chapters are mainly dealing with the situation in the USA, however, the history in most western countries is similar and the book is absolutely worth reading for those interested in public health and in the HIV/AIDS epidemic and policy. The public health challenges from infection diseases never stop.

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