Background:  In the United States, one of the most significant advances in HIV prevention research has been in the development of “Prevention for Positives.”

Methods:  This presentation uses the Ecologic Model of Health Behavior (McLeroy et al., 1988) to analyze both the success and challenges learned from current initiatives for prevention targeting persons living with HIV. For future prevention, 3 new directions are emphasized:  First, the prevention needs of HIV⁺ and HIV-undiagnosed men of color who have sex with men (MSM) must be prioritized. Second, the Internet provides new challenges and opportunities for HIV prevention. Examples from an intervention currently in trial will showcase how prevention may look in the future. Third, future HIV prevention programs and policy must address the challenges of both resurgent and endemic HIV in communities most affected by HIV.

Conclusions:  Whether the United States can effectively prevent the next phase of the epidemic without universal health care is argued.