July 23, 2008
On National HIV Testing Day on June 27, 2008 the CDC released data from 33 states indicating that new HIV diagnoses jumped 12 percent annually between 2001 and 2006 among young gay and bisexual men. Researchers said the rise was "especially concerning" for young black men aged 13-24 who have sex with men. For this group, the annual rate of new HIV diagnoses rose by 15 percent annually, compared to a 9 percent and an 8 percent annual rise among their white and Hispanic peers, respectively.
Overall, gay and bisexual men comprised 63 percent of all cases of new infection among U.S. males from 2001 to 2006, and almost two-thirds of new cases among men who have sex with men occurred in the 25- to 44-year-old age group.
These sobering numbers came against a backdrop of a much anticipated report -- to be released by the CDC on August 3, 2008 -- expected to indicate that, instead of experiencing 40,000 new cases of HIV infection a year for the last several years, the nation has actually suffered 50,000 new cases each year.
Additional funding is needed to do a more effective job of reducing new HIV infections in the United States. The Bush administration has promoted and Congress has gone along with failed policies like the scientifically unsound insistence on abstinence-based HIV prevention targeting youth. But these two problems do not fully explain why the nation has been unable to reduce new cases of HIV infection for the past 15 years. Increasingly, people working in HIV/AIDS are speaking of their frustration that we have not identified and agreed upon a set of prevention strategies that are most likely to be effective in the context of today's epidemic; that prevention research and practice are not sufficiently unified; and that the many government and community agencies working in prevention are not sufficiently coordinated to maximize impact on new infections.
Project Inform is actively involved in the effort to call on the next President to create a focused and targeted National AIDS Strategy within one year of taking office in January 2009. In addition to the urgent goals of identifying specific ways in which the nation will increase the number of HIV-positive Americans who are receiving care and treatment, and reduce health disparities affecting vulnerable communities, the Strategy is intended to identify specific policies and programs that will be used nationally to substantially reduce new HIV infections.
Project Inform has not historically been directly involved in HIV prevention activities. But in recent months, the Board and staff have added HIV prevention to the agency's mission. Why? Because it will be impossible to reach our goal of helping to control HIV/AIDS domestically without reducing new infections to their lowest possible levels. Because absent universal health care, which we support and will work on in with a new Administration in Washington, Project Inform cannot meet its goal of helping to guarantee quality health care to all HIV-positive people if 400,000 to 500,000 additional people become newly infected every decade.
Project Inform has no intention of becoming involved in behavioral prevention, in which so many agencies are already engaged. Rather, we will work where our expertise lies by advancing biomedical prevention -- strategies that bring medical technology to bear on new HIV infections. Some obvious forms of biomedical prevention will not be on our agenda, as they also have many agencies actively working on them. These include, of course, vaccine and microbicide development. Our work will be in support of promising strategies where additional development and advocacy are needed in order to progress.
Two examples are the national effort we are helping to lead along with Community HIV/AIDS Mobilization Project to determine how, if it succeeds in current clinical trials, Pre-Exposure Prophylaxis (PrEP) could be delivered and financed to keep high-risk, HIV-negative people from becoming infected. In the absence of a vaccine, PrEP would involve having HIV-negative people take antiretroviral medications in combination with practicing safe sex to increase the likelihood of remaining uninfected. Another example is our work, based on recent studies that strongly point to the merits of such a strategy, to encourage greater numbers of HIV-positive people to enter treatment as early as possible both to improve their clinical outcomes and substantially, if not completely, reduce the chances that they can transmit HIV to others.
The challenges of preventing new cases of HIV infection for vulnerable individuals and risk groups are complex and substantial, particularly in the current context of effective treatment for those who are HIV infected. Still, we can do a better job of preventing HIV in the United States using more sophisticated strategies and by coordinating the efforts of researchers and prevention agencies.
Project Inform would like to hear your comments about these issues, and our entry into HIV prevention. Please contact Dana Van Gorder.