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THE VIRTUAL VACCINE
A Ten-Point Plan to Reinvigorate Our National Commitment to HIV Prevention
July 20, 1998
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- Federal prevention funding at the CDC including education has been flat during the past three years ($617 million in FY97, $634 in FY98 and $634 proposed in FY99).
- Infection rates since 1996 have increased, especially among young people and communities of color. Women accounted for over one quarter (28%) of the HIV diagnoses compared to 17% of AIDS diagnoses from a recent analysis by the CDC of 25 states from 1994-97. The trends also indicate that African-Americans accounted for the majority (57%) of HIV diagnoses, compared to 45% of AIDS diagnoses.
- There are approximately 40,000 new infections every year, half of which are estimated to be among young people (under the age of 25). Despite a drop in death rates in other categories, AIDS remains the number one killer of African-Americans and Latinos age 25-44.
- The Congressional Black Caucus recently declared a "State of Emergency" because of the alarming rates of HIV/AIDS in the black community. Blacks and latinos make up 66% of AIDS cases, and blacks account for more AIDS cases than any other racial/ethnic group.
- Only 3,995 infections must be prevented annually to actually result in cost-savings.
- Increased funding should support a reinvigorated and renewed national HIV prevention effort that targets highest risk communities.
- Providing treatment on request for those using drugs would help fight both the wars on AIDS and illegal drug use.
- Nearly a third of all AIDS cases and approximately half of all HIV infections are attributed directly or indirectly to substance abuse.
- A Massachusetts study of young people revealed that teens were less likely to use condoms if sex followed drinking or drug use.
- The Clinton Administration should lift the federal ban on needle exchange funding and veto any bills that would jeopardize states from implementing needle exchange programs. Also, states and local communities should implement needle exchange programs, fully fund them, and facilitate access to clean syringes.
- As the first step toward treatment on request, Congress should pass and the President should sign into law $275 million in funding increases for substance abuse programs.
- Engage the U.S. Drug Czar, General McCaffrey, to strike a more equitable balance between treatment and interdiction in the fight against illegal drug use.
- A June study released by the NIH's National Institute of Mental Health revealed the extraordinary effectiveness of small-group counseling sessions. The 37-city study of 3,705 men and women of color demonstrated that targeted prevention including multiple group counseling sessions cut high-risk behavior in half and doubled regular condom use.
- The CDC should provide grants to community-based organizations to implement a nationwide roll-out of small-group educational and counseling sessions targeted to at-risk populations.
- Research illustrates vital need for comprehensive HIV prevention programs for adolescents. Effective programs will inform adolescents that making right decisions often takes more than knowledge, it also includes support from peers, parents, and the public health and at-large community.
- The CDC should launch a new testing campaign by improving the accessibility of HIV testing and ensuring that it is anonymous, confidential and private.
- As a part of this new testing campaign states and territories would be required, as a condition of receipt of federal funds, to have in place easily accessible HIV anonymous testing sites. In an AIDS Patient Survey, anonymous testers showed up for testing and medical care earlier in their HIV disease course than did confidential testers, demonstrating that anonymous testing contributes to enhancing early access to HIV testing and medical care.
- Studies indicate that ensuring the availability of anonymous testing increases the likelihood that people at risk would seek testing. An Oregon study demonstrates that there was on overall increase in testing by 50%: 125% for homosexual/bisexual men; 56% for female prostitutes; 17% for injection drug users; and 32% for other clients.
- The CDC should encourage testing vans and testing-mobiles that can help reach those who might otherwise not get tested at a clinic or doctor's office.
- The American Hospital Association should encourage hospitals to offer better HIV testing, including rapid and non-invasive procedures.
- Testing centers should implement rapid testing (results in 10 minutes vs. current week). Rapid testing would eliminate the high rate of patient return failure for results appointments. Under current tests, results are not available for at least a week. According to the CDC, 700,000 people who are tested each year do not return for their results.
- The CDC should oversee the implementation of an independent and vigorous new HIV prevention ad campaign.
- The marketing of these ads should follow the epidemic and should appeal to the communities most at-risk, giving fresh, accurate information.
- Enlist the help of adolescents to design and test ads intended for their generation. The Illinois Department of Public Health recently launched a prevention campaign using teens as messengers about the consequences of bad decisions.
- Instead of sensationalizing sex on TV, networks should portray sexual reality, not just fantasy. In addition, networks should allow condom ads on programs rated "S" for sexual content under the new TV rating system.
- Build comprehensive sexuality education curricula that include, but are not limited to abstinence only.
- Create an enhanced HIV/AIDS Prevention Web Page with links from popular web sites used by at-risk populations that would ensure widespread accessibility among young people.
- Deploy new technologies to allow individuals to access anonymous e-mail for prevention information as well as a national testing referral database.
- Urge states to gather accurate data including questions about same-sex behavior in a 1999 national youth risk behavior survey.
- In the anonymity of cyberspace, young people are 14 times more likely to reveal personal information, according to recent study from the Program in Health and Behavior Measurement at the Research Triangle Institute. The study demonstrates that respondents may be uncomfortable divulging potentially embarrassing information about themselves to a live interviewer, so researchers developed a computerized, self-administered survey designed to work around these problems.
- As part of HIV social marketing, the CDC should include a campaign to reduce HIV stigma and promote HIV-positive people working to protect their health and the health of others.
- Modify prevention programs to alter peer norms and reach young men at highest risk in social settings. At the World AIDS Conference, a study showed that nearly two-thirds of gay men reported engaging in unprotected anal sex at least once during the previous 18 months. Additionally, 56% of gay men under the age of 25 reported having unprotected receptive anal intercourse, a behavior that poses substantial risk for HIV infection, compared to 46% of older men.
- The CDC should develop ways to ensure that people living with HIV and receiving treatment adhere to drug regimens and work to prevent new infections among HIV-negative populations as well as their own re-infection.
- Public health departments should implement innovative programs to help eradicate STD's (e.g. syphilis) because of their role in facilitating transmission of the HIV virus.
- The Surgeon General should launch a mailing to all African-American and Latino households with information about HIV infection risks, stigma, sexually transmitted diseases and testing.
- African-Americans comprise 57 percent of new HIV infections in 25 states, despite accounting for only 13 percent of the total U.S. population.
- Young African-Americans have an even higher rate; those aged 13 to 24 years accounted for 63 percent of new HIV cases between January 1994 and June 1997.
- HIV has also increasingly affected women of all races. Of those aged 13 to 24 years, women now make up 44 percent of infections.
- Women of color are often the hardest to reach since many perceive themselves at low or no risk, yet are unaware of their sex partner's homosexual behavior or drug use.
- A majority of African Americans (52%) and one in two Latinos (50%) believe AIDS is the nation's leading health crisis, according to a survey by the Kaiser Family Foundation. Most African Americans (56%) say AIDS is a very serious problem.
- Physicians could do more to determine a patient's risk of contracting HIV, a recent report suggests. In 73% of doctor-patient encounters, "physicians did not elicit enough information to characterize patients' HIV risk status," according to the study conducted by Dr. Ronald Epstein of the University of Rochester School of Medicine and Dentistry and colleagues.
- Grants should be made available to AIDS Education and Training Centers to promote better HIV/AIDS knowledge in the medical community.
- A recent National Health Council survey found that a greater percentage of people named television as a primary source of their medical and health news (40%) than named doctors (36%).
- The AMA, ANA and other health provider organizations should work with the NIH to develop guidelines for better physician training so that HIV risks are better identified.
- HIV Vaccine development should be a top priority of the federal government. Increased commitment to the development of a vaccine should be accompanied by increased funding.
- In May 1997, President Clinton issued a challenge to the nation to develop an HIV vaccine within a decade.
- One year later, the President hasn't even named a director for the project. The President should act immediately to name a director and ensure a genuine commitment to the project.
This article was provided by AIDS Action Council.
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