The UC San Francisco AIDS Research Institute (ARI) will launch three new programs in 1999 aimed at preventing HIV infection.
The new initiatives are being announced today, Tuesday, December 1, as part of "World AIDS Day" activities at UCSF.
"Despite all of our efforts, we can expect thousands of Americans and millions around the globe to become infected with HIV next year and each year thereafter. It is evident that existing strategies have only gone so far," said Thomas J. Coates, PhD, director of the UCSF ARI. "The goal of these new initiatives is to make sure prevention is working as well as it can while we are simultaneously working on an HIV vaccine and better therapies."
"We need to do all we can to prevent new HIV infections, and we feel these projects represent a new era in which prevention efforts bridge two worlds that have long been separated: the HIV-infected and the uninfected populations," he added.
The new program initiatives are:
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Primary prevention among gay men -- Designed for HIV negative persons who
continue to engage in high-risk behavior, a new individualized counseling
approach named EXPLORE will be tested at half a dozen sites across the country.
Expected to involve more than 7,000 men, it will be the largest study to date on
primary prevention.
Unlike conventional counseling that provides two brief sessions with standard advice, EXPLORE is directed at the individual and ways he can change particular patterns of risk-taking. Each person will have the same counselor for 10 visits, and the focus will be on new behavior options, such as ways to meet people and establish relationships without risk, personal strategies to reduce the risk of infection when using alcohol or drugs, and plans to communicate with partners about risk, safety, and a future that will remain free of infection.
This multi-site study will be the first to test directly whether counseling can reduce the rate of new HIV infections, according to Margaret Chesney, PhD, UCSF professor of medicine with the UCSF ARI. Chesney and Coates designed the new counseling approach. If the strategy proves effective, they hope it will become a model for HIV prevention worldwide.
Reduction in spread of HIV infection -- This initiative targets HIV-infected men and women through risk-reduction counseling. Based on the same principles as EXPLORE, this project will not use group counseling but will focus on working with each individual to design personal strategies to reduce risk behavior and enhance quality of life.
The project will be coordinated initially through the UCSF ARI and three other major HIV research centers: UCLA, Columbia-Presbyterian Hospital in New York, and the Medical College of Wisconsin in Milwaukee. This approach is a response to evidence that HIV-infected people periodically engage in behaviors that risk the spread of the virus. Counseling will cover coping with the stress and stigma of HIV as well as advice on adhering to the current complex but life-saving medication regimens for HIV infection. Chesney is project principal investigator. The project is funded by the National Institutes of Mental Health.
Prevention planning -- The UCSF ARI Policy Center, directed by Steve Morin, PhD, received core funding from the Until There's A Cure Foundation to continue its efforts to develop into a major center on policy issues. The Center is now organizing the first "demonstration project" in the country targeted at disease prevention in young people. Funded by a grant from the San Francisco Foundation, the project will cover five Northern California counties and will work to develop programs on preventing HIV and sexually transmitted disease and on planning for good reproductive health. If the project proves successful, it is expected that it will be extended statewide with federal support, according to Morin.
The project will be directed by Mike Shriver, who now has joined the staff of the UCSF ARI. Shriver is former deputy executive director for policy of the National Association of People with AIDS in Washington, D.C. He previously served on the health commission of the City and County of San Francisco and was executive director of Mobilization Against AIDS.
"All in all, science is paying off. AIDS deaths have decreased by two-thirds, but new infections in the U.S. have not gone down in the U.S. and in the developing world have increased by 10 percent. We are continuing to do all that we can to prevent HIV through social, behavioral, and vaccine strategies, and our science will continue to pay off in the future," Coates said.
The UCSF ARI is an institute without walls that encompasses all UCSF AIDS programs under a single umbrella. It includes a dozen research institutes, a wide range of clinical, behavioral science, and policy programs, and nearly 1,000 investigators.