The shifting HIV/AIDS paradigm: twenty years and counting.

In just a few months, we will have known about the AIDS pandemic for 20 years. Initially, the HIV epidemics, and the official public responses to them, were defined through a medical paradigm traditionally applied to infectious disease control. If people were aware of risks and were given the means to protect themselves from these risks, it was believed, the epidemics would be tamed. Safe sexual practices, the screening of blood and blood products for HIV, the use of sterile injection equipment among drug users, and the avoidance of pregnancies by HIV-infected women would eliminate the risk of infection. By 1986, enough was known about the infectious agent (the virus), host factors (human biology and behaviors), and modes of prevention (risk elimination approaches) that the World Health Organization was able to launch a global strategy against HIV/AIDS. In response to the outcry from people affected by HIV that they suffered from both the health consequences of infection and intense discrimination, the protection of human rights of people living with HIV/AIDS formed an intrinsic part of the initial WHO Global Strategy. From a public health perspec-