The authors of "A New Deal in HIV Prevention" [1] deserve our thanks. Our human immunodeficiency virus (HIV) prevention tactics are not working.

Since the beginning of the epidemic, I cannot remember a serious discussion in any U.S. journal, or at any meeting, of contact identification and mandatory testing for HIV. At the Prevention '93 meeting, some physicians at the Centers for Disease Control and Prevention refused to discuss testing.

The epidemic is now established in our heterosexual population. Sexual practices in the United States differ little from those in Africa, and we have at least 800 000 HIV-positive Americans who do not know they are positive and who are sexually active. Testing of contacts of known HIV-infected persons is not unreasonable.

A lesson not mentioned in this article is that the only nation in which HIV infection rates are decreasing is Cuba; where mandatory testing and isolation of HIV-positive persons are the law.

The draconian methods used in Cuba are unnecessary because most people who are HIV-positive would follow the necessary precautions if they were aware they carried the virus. Most people do not want to kill others.

Identification of contacts and HIV testing may seem expensive ways to control the acquired immunodeficiency syndrome (AIDS); however, given the cost of the approximately 1.25 million HIV-positive persons who will die of AIDS, it is not a large investment.

My question, then, is why are contact identification and testing not serious topics of discussion? Is the issue so political that there is a conspiracy of silence?