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This issue of the Journal of urban health

The year 2001 marks the 20th year since the initial report of the acquired immunodeficiency syndrome (AIDS) in the Morbidity and Mortality Weekly Report. The initial report described homosexual men with Pneumocystis carinii pneumonia and other unusual infections. Soon thereafter, there were reports of more cases in homosexual men, hemophiliac patients, and injection drug users. As hemophilia and injection drug use affects mostly men, the early identification of these three risk groups shaped approaches to handling AIDS and then shaped the focus for human immunodeficiency virus (HIV) prevention activities. Although early in the US HIV epidemic reports of AIDS in women and perinatal transmission were published, a major focus on HIV infection in women was not raised until several years later. Early on, there were investigators who recognized that HIV infection would involve heterosexual transmission. Male condoms were an important barrier method to develop into expansive programs for preventing sexual transmission of HIV infection. Some recognized that the HIV epidemic would spread extensively if prevention efforts that centered on female-initiated methods were not developed and tested. In particular, Dr. Zena Stein has been an influential scientist from New York City who pushed strongly for female-initiated methods, before many others recognized the full need. Dr. Stein has continued to advocate energetically for this urgent need. Since that time, only one new product, the female condom, has become available; many other existing methods, such as the diaphragm and microbicidal formulations, are being tested or are under development to help stem the spread of HIV to women. New behavioral approaches that recognize the unique circumstances in which many women find themselves have also been developed. As the HIV epidemic continues to spread, especially in Africa, it is now much clearer than it was at the beginning of the HIV epidemic that multiple approaches involving both men and women, with a number of different product options, and behavioral strategies that are culturally and gender sensitive are needed. This issue of the Journal is devoted to research on female-initiated methods for preventing transmission of HIV and other sexually transmitted infections. Since the beginning of the HIV epidemic, great strides have been made in terms of reducing risk of transmission due to transfusion through careful screening. Also, perinatal transmission can be reduced significantly with judicious use of antiretroviral medications and other approaches. Risk of parenteral transmission among injection drug users can be reduced through a combination of outreach education, drug abuse treatment, and expanded sterile syringe access. However, sexual transmission continues to be a concern. Recent studies among male and female injection drug users have shown considerable reductions in parenteral risks, but risks related to sexual behaviors and lack of protective practices remain a problem. In a number of communities, both domestically and especially internationally, sexual transmission of HIV infection continues at alarming