California HIV/AIDS Prevention Programs To Focus on Training HIV-Positive People To Prevent Spreading Virus

California's HIV/AIDS prevention efforts, which in the past have focused on curbing high-risk behavior, are being "revamped" to train HIV-positive people not to spread the virus, the Los Angeles Times reports. The "new tactic" in HIV/AIDS prevention "is set for substantially expanded use in California and the rest of the country in the next several months," according to the Times (Costello, Los Angeles Times, 9/29). The CDC in April announced a new HIV/AIDS prevention strategy that will shift funding distribution away from community groups that provide education aimed at reducing unsafe sexual and drug-use behaviors in people who have not contracted HIV. According to the strategy, the government will invest most heavily in initiatives that focus on identifying people who are already HIV-positive, which could jeopardize approximately $90 million in annual federal funding for community groups. The CDC has said that the current emphasis on community outreach prevention programs has proven ineffective, citing annual increases in the number of new HIV cases nationwide (Kaiser Daily HIV/AIDS Report, 8/18). In a "surprising step," California's Office of AIDS last year shifted up to 25% of its prevention funding to "prevention for positives" programs, the Times reports. The new prevention strategies will likely benefit programs that include "one-on-one" counseling with HIV-positive patients and their sex partners; routine testing inside and outside medical settings, including use of the rapid HIV test; mental health, drug abuse and "self-esteem" therapy; and efforts to prevent mother-to-child HIV transmission, according to the Times.

Reaction
Drew Johnson, head of education and prevention for the Office of AIDS, said, "I know it sounds trite to say, but the reality is that every newly diagnosed HIV case is the result of someone who is positive that's spreading the disease. We need those with the disease to help us stop or at least slow its spread." Some HIV/AIDS advocates are concerned that the new prevention strategy could "backfire," according to the Times. Dr. Octavio Vallejo, a faculty member at the UCLA AIDS Institute, said, "This one-size-fits-all policy assumes everyone is knowledgable about the disease and wants to get tested regularly. That's not the case." Fernando Sanudo of the Vista Community Clinic near San Diego, Calif., said he believes traditional outreach prevention programs work best for his clientele, who are mainly African-American and Latino. Dr. Tom Coates, professor of infectious diseases at University of California-Los Angeles Medical School, said that researchers "have a far way to go before [they] know this [prevention strategy] works." He added that the CDC's prevention strategy, which includes a call for wider HIV testing, is being implemented when state programs are facing budget shortfalls, leaving "little extra money to help newly diagnosed HIV patients pay for the treatment and medications they will need," the Times reports. Coates said, "These policies are being promulgated at a bad time," adding, "I wish we could have waited until there was more evidence" or more funding for the program (Los Angeles Times, 9/29).