CDC HIV Prevention Program Aims to Cut New Infections in Half by 2005

The CDC yesterday announced a new effort intended to "break the back" of the AIDS epidemic by halving the number of new HIV infections by 2005, the AP/Philadelphia Inquirer reports. The CDC's Serostatus Approach to Fighting the HIV Epidemic, or SAFE program, is based on the assumption that "most HIV infections are spread by outwardly healthy people who do not realize they have HIV" and intends to reduce the number of new infections from 40,000 a year to 20,000 by 2005 (Haney, AP/Philadelphia Inquirer, 2/7). The CDC, which already spends nearly $700 million a year on AIDS prevention, estimated that it will need to increase its budget to $900 million a year to cover the campaign. Dr. Helene Gayle, director of the agency's AIDS program, said she did not know how much the CDC would officially request because "the transition to a new administration has left the budget process unclear." However, in a meeting with top HHS staff last week, newly confirmed Secretary Tommy Thompson said that AIDS is a "top priority" for the administration (Schoofs, Wall Street Journal, 2/7). Gayle added that the funding estimates are what academic researchers and health departments estimate "it would realistically take" to meet the program's goals. "It's a matter of what our society is willing to pay for," she added (AP/Philadelphia Inquirer, 2/7).

New Plan of Action
Dr. Robert Janssen, director of the CDC National Center for HIV, STD and TB Prevention's Division of HIV Prevention, Surveillance and Epidemiology, yesterday presented an outline of the program at the 8th Conference on Retroviruses and Infectious Diseases in Chicago. The program, which "expands upon existing prevention efforts," will initially focus on expanding voluntary counseling and testing programs, targeting communication efforts and expanding community-based voluntary HIV testing and routine voluntary testing in community health centers, STD clinics and emergency rooms. The CDC plans to release this spring revised Guidelines for HIV Counseling and Testing, which will for the first time "target" private physicians as well as public clinics (CDC release, 2/5). The agency will also launch a new media campaign, "Know Now," utilizing radio and bus ads in neighborhoods where "HIV is most common." The ads will initially be tested in Detroit, New Orleans, Houston, Miami and Jackson, Miss. The CDC will also work with the FDA to bring to market later this year rapid HIV tests, which give results in 15 minutes using a drop of blood or saliva and can be used outside of clinical settings (AP/Philadelphia Inquirer, 2/7).

Fighting 'Prevention Fatigue'
The CDC gave several reasons for "intensify[ing] efforts to reach infected individuals," whom they say are "contributing significantly" to new HIV infections. First, once individuals know they are infected they can "benefit from prophylaxis for opportunistic infections, monitoring of their immune status, antiretroviral therapy ... and, if needed, substance abuse and/or mental health treatment." Second, studies show that "most infected individuals take steps to protect their partners" once they are aware of their status (CDC release, 2/5). Nine in 10 HIV-positive Americans were shown to be "more likely" to practice safe sex during the year after they learned they were infected, one CDC survey found. "But most have trouble keeping it that way," Janssen added. A new study from Amsterdam presented at the conference found an increase in unprotected sex among 84 HIV-positive gay men after "potent" drug therapies lowered the levels of virus in their blood to "undetectable levels" (Laino, MSNBC.com, 2/7). This "tendency to revert to unsafe practices," seen among "some youthful populations," suggests that "'prevention fatigue' sets in as people with the AIDS virus live longer and healthier lives." The recent rise in STD rates in many U.S. cities is "evidence that the trend is occurring," the Washington Post reports. In a survey of 250 HIV-positive patients at New York's Bronx-Lebanon Hospital Center, about 40% of respondents reported having unprotected sex after learning of their serostatus. It was most common among women (50%) and "people who traded sex for drugs or money" (65%). Within a year of learning their status, 29% had unprotected sex, while at the five-year mark, 36% reported "high-risk behavior." After five years 54% reported having "at least occasional unprotected sex." Among those who had known they were HIV-positive for more than five years, 34% contracted another STD. This finding is "important" because STDs such as gonorrhea and syphilis "greatly increase" the risk that a person will transmit or acquire HIV. The question of whether the rise in STDs will lead to increased HIV infections "remains to be answered," according to Gayle, "But we have all the ingredients with us now to say that it could" (Brown, Washington Post, 2/7).