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ARE WE SENDING OUT THE RIGHT MESSAGES?
May 27, 2009

First let me explain the reason why I have sent this message. I am a male (gay) living with HIV and have been for over 20 years. It as always been my principle and value to practice what I preach. In other words safer/safe sex is a must for all. Positive people to positive people and positive people to negative people (visa versa). I am also a long-term non-progressor/survivor.

So now to my question. Are we sending out the right messages concerning people living with HIV and an un-detectable viral load (whatever). Prevention of HIV and other sexually transmitted infections are more paramount today as it was over 25 years ago.

Mixed messages make it harder for people living with HIV to overcome stigma and prejudice irrespective of being male or female and of other cultures and backgrounds.

ARE WE SEDNING OUT THE RIGHT MESSAGE (IN ACCORDANCE TO THE SWISS REPORT)?

Response from Dr. Frascino

Hi,

There is no doubt our HIV-prevention messages are outdated and clearly not effective as evidenced by the 56, 300 new infections that occur in the U.S. every year (a 40% increase over what was previously reported). HIV is, after all, 100% preventable. We know what to do, but we just aren't doing it. Obama and his team are crafting a national HIV/AIDS strategy. Bush/Cheney never bothered to do this, as they were too busy screwing up the economy, the environment, Iraq, Afghanistan, the world and the universe.

I'll reprint some information from the archives that discusses my feelings regarding HIV prevention and Obama's plans to cut spending on abstinence only sex education.

Dr. Bob

Prevention equals condoms. Period. Right? (HIV PREVENTION SPECTRUM 2009) May 5, 2009

Dr. B,

HIV prevention isn't all that complicated. Just use condoms. End of story. Right?

Zeb

Response from Dr. Frascino

Hi Zeb,

Well, I agree condoms may be the most effective HIV-prevention tool we have to date. However, it is far from the only tool or intervention in the prevention armamentarium! Effective HIV prevention is far more complicated than you might imagine and condoms alone are not the "end of story" solution to the HIV pandemic! I believe a "prevention spectrum" is really the best way to think about an effective HIV prevention strategy.

We know that what we are currently doing is not working. How do we know that? Simply by looking at the rate of new HIV infections that are occurring across the globe each year. Even in the U.S. the number of new HIV infections has not declined. In fact the number of new infections per year has increased to 56,300 per year!! A key point to remember is that HIV is 100% preventable using the tools and knowledge we have today.

An effective prevention strategy should begin well before a potential HIV exposure with science-based, age-appropriate sex education that emphasizes STD awareness and prevention. In addition pre-exposure prevention strategies should include behavior change for those participating in risky sexual or drug-injecting activities. We also need to increase clean-needle exchange programs, STI treatment programs, circumcision (especially in resource-poor countries) and availability of PrEP (if it is proven to be effective).

Prevention strategies at the time of exposure would include condoms (both male and female), antiretroviral therapy to prevent mother-to-child transmission in HIV-positive pregnant women. We are also working to develop effective microbicides for vaginal and rectal use and more effective cervical barriers (diaphragm).

Finally, preventive measures even after exposure should be ramped up. These include increased awareness and availability of PEP (post-exposure prophylaxis) and increased testing to identify those who are infected so that risky behaviors can be modified and treatment begun. HIVers with undetectable viral loads have a significantly decreased risk of transmitting the infection to others. Likewise prompt recognition and treatment of concurrent STIs can decrease the risk of transmission of HIV to HIV-negative sexual partners.

Eventually we hope to develop the ultimate HIV-prevention tool, an effective preventative vaccine. However, such a vaccine is not even on the distant horizon yet. Consequently for now and the foreseeable future we should more effectively utilize the entire HIV-prevention spectrum armamentarium, including but not limited to male condoms.

Dr. Bob

OBAMA BUDGET WOULD KILL ABSTINENCE-ONLY FUNDING

By Jonathan Allen, CQ Staff President Obama plans to eliminate funding for abstinence-only sex education programs and replace it with money for more inclusive forms of teen pregnancy prevention.

The predictable and potentially controversial reversal of Bush administration policy on abstinence was announced with little fanfare in the 1,380-page budget appendix released by the White House on Thursday morning.

But it was greeted with quick and hearty approval from longtime critics of abstinence-only education.

"Finally we have a president who gets it," said California Rep. Barbara Lee , chairwoman of the Congressional Black Caucus and author of legislation (HR 1551) aimed at providing more comprehensive sex and disease education to students.

In place of the abstinence-only funding, which has been roughly $110 million per year in discretionary spending and $50 million per year in mandatory spending under national welfare laws, the president would direct money to teen pregnancy prevention programs.

The mandatory spending, often referred to as Title V funding, is already set to expire in June. Under Obama's proposal, money that would have gone to that program would be combined with $110 million in year-to-year discretionary spending to fund programs that replicate proven methods of reducing teenage pregnancies. At least $75 million would have to be spent on programs known to delay sexual activity and to increase contraceptive use.

The Department of Health and Human Services describes the shift in thinking this way: "Previous evaluations indicate that the most positive results come from high intensity youth development programs that provide a range of services in addition to comprehensive sex education, such as after school activities, academic support, or service learning."

The National Abstinence Education Association said in a statement that the White House plan "disregards the growing body of evidence supporting the effectiveness of abstinence education," including research showing "a 50% decrease in sexual onset among teens that are enrolled in abstinence programs."

"At a time when teens are subjected to an increasingly sexualized culture, it is essential that common-sense legislators from both sides of the aisle reject this extreme attempt to de-fund the only approach that removes all risk," said NAEA Executive Director Valerie Huber.

That view was echoed on Capitol Hill among conservative Republicans.

"The congressman thinks it's a mistake that (Obama's) basically hijacking funds," said Andrew Cole, a spokesman for House Republican Values Action Team chairman Joseph R. Pitts of Pennsylvania.

The president could also face opposition as well from some conservative Democrats, who have resisted past efforts to eliminate abstinence-only programs.

House Appropriations Committee Chairman David R. Obey , D-Wis., has taken up their cause in the past. An Obey spokeswoman could not be reached for comment. But last year, Obey and Democratic appropriators initially beefed up the president's request for abstinence-only funding in an effort to win support for the Labor-HHS-Education spending bill from Republicans. Ultimately the funding was dropped below its fiscal 2008 level of $109 million.

In the omnibus spending bill Obama signed into law earlier this year, abstinence programs got $95 million, a substantial reduction from the $151 million once backed by Obey.

Critics of abstinence-only sex education programs point to a study commissioned by the Health and Human Services Department that concluded young people in abstinence-only programs were no more likely to refrain from sex than their peers in other pregnancy prevention programs.

"Abstinence only doesn't work. You have to have abstinence plus," said Lee, whose legislation would give states annual grants to promote "family life education," including instruction in the use of abstinence and contraception.

In the omnibus spending bill Obama signed into law earlier this year, abstinence programs got $95 million, a substantial reduction from the $151 million once backed by Obey.

Critics of abstinence-only sex education programs point to a study commissioned by the Health and Human Services Department that concluded young people in abstinence-only programs were no more likely to refrain from sex than their peers in other pregnancy prevention programs.

"Abstinence only doesn't work. You have to have abstinence plus," said Lee, whose legislation would give states annual grants to promote "family life education," including instruction in the use of abstinence and contraception.



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