It's tough to argue with good news. On the same day that an Institute of Medicine committee that we cochaired released a report strongly urging the nation to make HIV prevention a top priority, another study was released touting a new breakthrough in AIDS treatment. To be sure, such remarkable advances in AIDS treatment deserve fanfare. But there is a danger in focusing on only the good news. People start believing that they can stop worrying about AIDS.

The latest statistics on new HIV infections illustrate all too well that nothing could be further from the truth. Despite 20 years of battling AIDS and HIV, the virus that causes AIDS, more than 100 Americans still become infected with HIV every day. And although new AIDS cases have declined dramatically among men who have sex with men, some metropolitan areas such as New York City, Los Angeles, San Francisco, and Miami are seeing an increase in HIV infection rates. What's more, the disease is spreading faster among women, minority populations, and young people.

It's time to state what may seem like the obvious. AIDS will never be eliminated in the United States unless the nation adopts an explicit goal: to avert as many HIV infections as possible with available resources. It's hard to believe, but many current HIV prevention efforts do not operate with this objective in mind. This is a real tragedy, considering that hundreds of new HIV infections could be avoided each year if greater emphasis were placed on prevention, and if our prevention dollars were spent more wisely.

Part of the problem lies in the way prevention funds are allocated. Currently, federal funding for HIV prevention across the country is appropriated largely according to the number of observed AIDS cases. That makes perfect sense if the goal is AIDS treatment. But decisions on how to allocate prevention dollars should be guided by principles of cost-effectiveness rather than simply by the number of AIDS cases. Routine evaluations of prevention programs are needed so those that do not work, or that are very expensive in relation to the number of infections they prevent, could be abandoned.

For example, a large number of new HIV infections in 1999 appeared among young people, and most were attributed to sexual activity. The federal government has appropriated $250 million in federal funds to be spent for abstinence-only sex education programs without any evidence that this approach is effective in reducing the risk of any sexually transmitted diseases, including HIV. Yet comprehensive sex education and condom availability - which have been shown to be effective in changing risky behavior - are not always supported. Federal, state, and local requirements that public funds be used for abstinence-only sex education should be eliminated.

Yet another example: Of the 46,400 new AIDS cases reported in 1999, injection drug use accounted for 22 percent. Sharing contaminated needles is the primary route of infection among injection drug users. But certain federal and state regulations restrict funding for needle-exchange programs, despite clear evidence that these programs avert new HIV infections without increasing the level of substance abuse. These restrictions need to be lifted. At the same time, federal agencies should ensure that resources for substance-abuse treatment are sufficient to provide services to all those requesting it.

Advances in HIV vaccines, microbicides, antiretroviral therapies, female condoms, and rapid HIV testing could significantly increase the effectiveness of prevention efforts. But insufficient funding for research and development of these products and the lack of incentives for the private sector to invest in them are hindering efforts in these areas. Greater public and private investment in the development of these new tools and technologies is needed to expand HIV prevention efforts.

Changes in the AIDS epidemic during the past two decades clearly illustrate that prevention can be effective. But the nation cannot afford to become complacent. The price for ignoring the resurgence of new HIV infections around the country simply is too high. The United States can - and must - do more to prevent the spread of HIV and AIDS.