HIV and the need for a voluntarist approach.

After a decade of fighting AIDS, the public health community has come to recognize that strategies to combat the infection must be premised on voluntarism and not on coercion. Attempts to combat AIDS with coercive public health strategies stem from a desire to force AIDS into an ill-fitting traditional disease-response framework, overlooking the differences between HIV and other sexually transmitted diseases, including the limitations in available treatment modalities for HIV. A return to such a cramped, narrowly-medicalized view of the AIDS epidemic has enormous social implications and a coercive strategy would frustrate efforts to stem the spread of the disease. Further, such strategies would hamper the willingness of those in need of medical care and education to benefit from existing programs. This essay explores some of the possible explanations for the apparent erosion of the voluntarist consensus and calls for a return to such a voluntarist approach through effective health care and education efforts.