Integrating HIV risk reduction into the medical curriculum.

The HIV epidemic in the USA continues to expand, with over 42 000 incident cases in 2002. Additionally, several US metropolitan regions have experienced dramatic increases in sexually transmitted disease (STD); for example, the syphilis case rate in San Francisco increased by 167% between 2001 and 2002. Medical curricula need to provide students with current information about STD, including HIV, along with skills with which to work with patients to reduce the risk of such diseases. This is particularly important in urban centres where patients come from diverse sexual and drug-using communities. Doctors play a critical role in preventing STD, yet nearly 44% of all US medical schools have no specific clinical training in STD prevention and counselling. Why change was necessary The University of California San Francisco recently integrated its undergraduate medical curriculum across traditional disciplines, a process which involved the integration of cultural and behavioural facets of illness and prevention. Year 2 students identified deficiencies in the Inflammation, Infection and Immunity (I-3) block, in that much of the material on STD/HIV required updating. Students proposed these changes: