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July 14, 2004

AIDS, Society

JAMA. 2004;292(2):276-277. doi:10.1001/jama.292.2.276

Different historical periods have faced different challenges in infectious disease control and public health, yet the fundamental elements are unchanging: agent, host, environment, and the dynamic interplay among them. History is easier to write in retrospect, but the outcome of any epidemic can be readily predicted by analyzing that interplay. Mutations resulting in increased virulence of an organism, entry into new populations or species, or the development of drug resistance will all favor the spread of infection. Host immunity, risk behavior, and health care service use will all impact host vulnerability to infection. Poverty, unequal access to health care, and criminalization of socially disapproved behaviors can increase the vulnerability to disease of certain populations. With chilling predictability, the unprecedented spread of the AIDS epidemic during the past several decades can be understood—and further predicted—by an analysis of these several dimensions.