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New
strategies for the new realities of HIV
- While HIV prevention has played a
major role in combating AIDS over the past 20 years, new
strategies are essential to address an increasingly complex
epidemic.
- Prevention successes in the 1980s
and 1990s helped significantly reduce annual HIV infections from a
peak of 150,000 per year to 40,000 per year, but making further
reductions will require a major expansion in prevention.
Developed
through extensive consultation with a wide array of prevention
experts inside and outside the agency, the new strategic plan
establishes the following:
- Mobilization to increase the
proportion of HIV-infected individuals who know their status.
- New prevention programs and
services for individuals living with HIV, combined with improved
linkages to treatment and care.
- Highly targeted prevention
programs for HIV-negative individuals at greatest risk.
Five-year
prevention goal
The plan expands CDC's existing
approach to prevention in the United States to reach the following
key goals by 2005:
- Through voluntary counseling and
testing, increase to 95 percent, from the current estimated 70
percent, the proportion of HIV-infected people who know they are
infected. Nearly 300,000 Americans who are HIV positive are
unaware of their infection.
- Increase to 80 percent, from the
current estimated 50 percent, the proportion of HIV-infected
people who are linked to appropriate prevention, care and
treatment services -- linking more of the 800,000 to 900,000
HIV-positive Americans to prevention and care services.
- Decrease by 50 percent the number
of individuals at high risk of acquiring or transmitting HIV
infection by delivering targeted, sustained and evidence-based HIV
prevention interventions.
A new approach to prevention --
SAFE: CDC's prevention program for HIV-positives
In February, CDC announced SAFE, a
major new component of the five-year strategic plan. SAFE, an
acronym for serostatus approach to fighting the HIV epidemic,
specifically targets services to those infected with HIV by
significantly increasing voluntary testing to identify HIV-positive
individuals and by linking those infected to prevention, treatment
and care.
As part
of SAFE, CDC is proposing a range of voluntary counseling and
testing options to make testing easier, including:
- Making anonymous and confidential
HIV testing widely available in all public and private health care
settings, including community health centers, STD clinics and
hospital emergency rooms.
- Evaluation and adoption of rapid
testing technologies to enable testing in nontraditional sites
such as street outreach programs.
- Working with national, state and
local partners to develop additional programs to increase
knowledge of HIV infections, including new testing programs and
partner referral efforts.
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SAFE
provides prevention services specifically suited to individuals
living with HIV, in order to help them protect others from
infection, and links them with treatment and care. Expanded efforts
include:
- Testing and development of HIV
prevention messages and campaigns specifically targeted to those
with HIV (e.g., HIV-positive people of color, newly diagnosed
individuals).
- Research into behavioral
interventions that work best to help HIV-positive individuals
reduce risk behavior and maintain safer behaviors.
- New research to identify "hard to
find" individuals and link them to services that meet their needs.
- Studies of what works best to
help individuals living with HIV adhere to complex treatment
regimens.
Importance of prevention for HIV-positive individuals
There are
several reasons to intensify efforts to reach infected individuals:
- People who know they are infected
can benefit from prophylaxis for opportunistic infections,
monitoring of their immune status, antiretroviral therapy (when
recommended by their physicians), and, if needed, substance abuse
and mental health treatment.
- Studies indicate that after
learning their HIV status, most infected individuals take steps to
protect their partners.
- New HIV therapies, by lowering
viral load, may reduce the degree of infectiousness. While
antiretroviral therapy will not eliminate transmission of HIV at
an individual level, it could theoretically reduce that risk,
which at a population level could affect the course of the
epidemic. More research is needed to confirm this theory.
Expanding
prevention in the U.S.
As part
of CDC's new five-year prevention strategy, SAFE expands upon
existing prevention efforts -- it does not replace them.
- Traditional HIV prevention
efforts, proven to change behaviors and decrease risk among
high-risk HIV-negative individuals, will remain a fundamental part
of CDC's HIV prevention portfolio.
- CDC currently provides almost
$400 million to state and local prevention programs targeting
high-risk individuals.
- CDC's current approach to
prevention funding at the state and local level ensures that HIV
prevention programs are culturally relevant and highly targeted to
those at highest risk.
[Centers
for Disease Control and Prevention] |
