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The end of the twentieth century has brought a new understanding about opportunities and challenges in public health, personal health and primary care in the United States and globally. (1, 2) The opportunities and challenges in the prevention of sexually transmitted infections (STIs) including Human Immune Deficiency Virus (HIV) are similar. The central barrier to effective prevention of STI/HIV is not the lack of efficacious interventions. Difficulties encountered in large scale implementation of such interventions; maintenance of intervention fidelity and quality over time; appropriate targeting of subpopulations central to spread of infections; monitoring of intervention implementation and resultant continuous quality improvement are among the factors that affect achievement of public health impact, despite the existence of efficacious interventions. In the context of increasingly scarce financial resources, these barriers assume even greater significance. A recent review of research on interventions for prevention of sexually transmitted infections including HIV concluded that although many interventions were found to be effective against STIs and HIV, few had been replicated, widely implemented or carefully evaluated for effectiveness in other settings. (3) A large majority of reviewed interventions were individual level, single modality interventions that aimed to prevent acquisition of infection in uninfected individuals. At this juncture, it is crucial that the public health discourse in general and the STI/HIV prevention discourse in particular evolve to include strategic approaches to epidemiology and prevention. A better understanding of the changing and interactive role of social determinants and the community in the spread of ill health; the central role of health systems, their structure and functioning in the implementation of prevention interventions; and all the parameters that bridge the gap between efficacious prevention in study subjects and public health impact reflected in declining morbidity, is called for. Such integrated understanding may indeed form the basis for the formulation of strategic approaches to the study of STI/IHIV epidemiology and the creation of realistic, feasible and cost effective prevention plans.