No Turning Back

Working on Three Fronts

CDC's approach to prevention involves three basic components: tracking the epidemic, helping communities, and researching prevention.

Tracking the Epidemic

Close monitoring of disease trends is essential to the ability of public health officials to devise effective disease prevention strategies for MSM and other populations. Since AIDS first appeared, CDC has collected and disseminated the best available information on disease trends.

To ensure that prevention programs are directed to those most in need, it is essential to track recent HIV infections that characterize the "cutting edge" of the epidemic. Collecting this information requires development and use of the latest surveillance methods and technology.

STARHS Testing

CDC's development in 1998 of new testing technology called STARHS (Serologic Testing Algorithm for Recent HIV Seroconversion) permits researchers for the first time to differentiate between recent and older infections. The approach tests blood with two separate antibody tests, each with different abilities to detect HIV antibodies. Blood that tests positive on one test but negative on the other reflects HIV infection within the previous four to six months.

Use of this technology in the Young Men's Survey enabled CDC to document the rapid pace at which young MSM in some cities, especially African Americans, are becoming newly infected with the virus. Some state and local health departments have already used STARHS to assess new HIV infections, and CDC anticipates even greater use of this new technology in the future.

HIV/AIDS Surveillance

To monitor the actual course of the epidemic in the treatment era, it is necessary to track HIV infection itself, rather than AIDS cases. Prior to the advent of highly active antiretroviral therapy (HAART), HIV progressed to AIDS within predictable intervals, allowing public health officials to identify populations most at risk with some degree of accuracy through analysis of AIDS trends. HAART, however, can delay or stop the progression from HIV to AIDS, meaning that HIV infection, not AIDS cases, is the more accurate gauge of the epidemic's leading edge. Therefore, CDC recommends that all states collect reports on diagnosed HIV infections, as well as AIDS cases.

As of mid 2001, 46 states and territories have extended their AIDS surveillance to include some form of HIV reporting for adults and adolescents. By providing a fuller picture of the epidemic than is possible with reports of AIDS cases alone, a national system of HIV reporting will increase the public health ability to respond effectively to emerging disease trends.

Surveillance Studies

CDC also conducts supplemental studies to get a clearer picture of where, how many, and why new infections are occurring. These studies include snapshots of the number of existing and new infections in populations at high risk, and analyses of risk behaviors, HIV testing patterns, and attitudes in groups of recently infected individuals. For example, CDC's Supplement to HIV/AIDS Surveillance project uses current national surveillance systems to collect additional data on risk behavior
among HIV-infected people.

STD Prevalence and Risk Behavior

To more effectively track the level of risk and other STDs among MSM, CDC has expanded STD surveillance to monitor STD prevalence and risk behaviors among MSM attending public clinics and other venues in 12 cities.