News Release

Committee calls for improved tracking, action to cut rate of new HIV infections

Peer-Reviewed Publication

University of North Carolina at Chapel Hill

CHAPEL HILL -- U.S. efforts to thwart the spread of HIV -- the virus that causes AIDS -- have slowed rapid growth of the epidemic, but the number of new infections remains unacceptably high, a national committee has concluded.

A new strategy focused on tracking HIV infections better, coupled with funding the most cost-effective prevention programs, could significantly cut new infections, says committee member Dr. Myron Cohen, professor and chief of infectious diseases at the University of North Carolina at Chapel Hill School of Medicine.

The Institute of Medicine, a nonprofit private institution that provides health policy advice to the nation under a congressional charter granted to the National Academy of Sciences, developed the report and released it in Washington, D.C. today (Sept. 27).

"Our report represents a major rethinking of prevention efforts for the United States that if put into place could have a dramatic, positive impact on the epidemic, which is not going away," Cohen said.

Other key needs include making HIV prevention services for at-risk and infected individuals routine in all clinical settings and abolishing laws and policies that block use of proven prevention strategies, the physician said.

"Thousands of new HIV infections could be avoided each year if we gave greater emphasis to prevention, and were smarter in the way we spent our prevention dollars," said Dr. Harvey Fineberg, Harvard University provost and co-chair of the 16-member panel. "Improved treatments may have contributed to a false sense of security and a dangerous complacency, but the need for prevention has not diminished one bit."

Recent reports suggest a resurgence of risky behaviors among homosexual men, as well as increasing rates of infection in some parts of the country, Fineberg said. The last 15 years have witnessed a shift in the U.S. AIDS epidemic, with a dramatic decline of new AIDS cases among homosexual men. At the same time, the number of new AIDS cases among women, minorities, and adolescents has increased considerably. Keeping up with the changes requires a better tracking system and a proactive approach -- one that can deliver more effective prevention services to those at greatest risk.

Given those challenges, the U.S. Centers for Disease Control and Prevention asked the institute to develop a framework for a national HIV prevention strategy. The committee said the nation should adopt an explicit policy goal -- to avert as many new HIV infections as possible within the available prevention resources -- and consistently work toward that goal. Accomplishing that will require changes in the way the epidemic is tracked and in federal prevention funding decisions.

In fiscal 1999, federal spending for HIV/AIDS prevention was about $775 million, or 8 percent of total federal spending for HIV/AIDS-related programs, Cohen said. Funding for HIV prevention largely mirrors the number of AIDS cases reported in specific populations and geographic areas. While the approach may be useful for allocating treatment funds, it is inappropriate for allocating prevention services. Funding decisions should focus on preventing as many new HIV infections as possible. A better system is needed for tracking new infections.

"The current epidemiological surveillance system does not provide a complete or accurate picture of the incidence of HIV infection," said co-chair Dr. James Trussell of Princeton University. "By focusing mainly on AIDS cases, where diagnosis lags behind HIV infection by approximately 10 years without treatment and even longer with treatment, today's system looks at the past rather than to the future and tracks where the epidemic has been rather than where it is going. This lag is particularly problematic in light of the reality that the epidemic has shifted into new population groups."

The CDC should create a national surveillance system to identify new HIV infections, enabling public health officials to track recent changes in the epidemic, he said. Rather than trying to count every newly infected person, the committee's approach would estimate the number of new infections by testing a statistically valid sample of those at the highest risk. These people would be drawn from "sentinel" sites, including health care facilities -- such as sexually transmitted disease, tuberculosis, substance-abuse and family planning clinics.

Social, economic, and cultural forces not only shape the AIDS epidemic, but also influence the nation's response to it. Poverty, racism and reluctance to openly address sexuality and misperceptions about HIV/AIDS continue to fuel the epidemic and undermine control effort effectiveness. For example, social and political pressures have led to policy and legal obstacles that block the use of proven strategies. Such laws and policies should be abolished, the committee said, including federal, state, and local requirements that public funds be used for abstinence-only sex education.

Nationally, the federal government has appropriated $250 million to be spent over five years for abstinence-only programs -- without evidence that the approach is effective. Yet comprehensive sex education and condom availability have been shown to reduce the risk of HIV and other sexually transmitted diseases without promoting sexual activity. This recommendation takes on added urgency given that the majority of AIDS cases reported in 1999 among adolescents were attributed to sexual activity.

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Copies of the report, " No time to Lose: Getting More from HIV Prevention," are available from the National Academy Press, 1-800-624-6242.

Note: Reporters can page Cohen at 919-216-1926. Contact: David Williamson, 919-962-8596.


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