HIV/AIDS Prevention Programs To Lose Funding Next Year Under New Plan Focusing on Already Infected Individuals
Federal funding for HIV/AIDS prevention programs aimed at HIV-negative individuals will experience a "substantial shift in priorities" next year, as federal officials are now focusing on educating HIV-positive people about prevention and testing, the Los Angeles Times reports. During a conference call yesterday, Dr. Rob Janssen, the CDC's director of HIV prevention, said that the government will invest "most heavily" in initiatives that offer HIV testing and counseling to HIV-positive people, which puts approximately $90 million in annual federal funding for community groups "[a]t stake," according to the Times. Janssen also said that the changes would be finalized in three to six weeks and could be in effect by July 2004. CDC spokesperson Tom Skinner said that the agency has not yet identified what programs will become ineligible for federal funding, the Times reports (Ornstein, Los Angeles Times, 4/18). The agency yesterday announced new guidelines for HIV prevention programs, Reuters/New York Times (Reuters/New York Times, 4/18). The guidelines, outlined in today's Morbidity and Mortality Weekly Report, include provisions for an opt-out testing program for pregnant women in an effort to reduce mother-to-child HIV transmission. The strategy calls for all pregnant women to be tested for HIV, along with a battery of other routine tests already conducted on pregnant women, including tests for syphilis, rubella, group B Strep and hepatitis (Kaiser Daily HIV/AIDS Report, 4/17). The guidelines also include:
- Offering routine HIV tests as a part of medical appointments for patients at high risk;
- Offering rapid HIV tests in non-medical settings, including jails and homeless shelters; and
- Tracing partners of those who test positive for HIV in order to offer them testing and prevention education (McKenna/Wahlberg, Atlanta Journal-Constitution, 4/18).
The CDC plan "sidestepped politically thorny questions" surrounding safe-sex practices, needle-exchange programs and "abstinence until marriage" education, the Washington Post reports. The agency has not yet said how it will "work out many details" of the guidelines, including how to encourage identifying and treating partners of HIV-positive individuals (Connolly, Washington Post, 4/18). However, the agency has said it is allocating approximately $40 million for the new projects (Reuters/New York Times, 4/18). CDC Director Julie Gerberding said, "Our prevention efforts have stalled, and we are not making the kinds of ongoing progress in reducing new cases that we would expect to be able to achieve" (Knox, "All Things Considered," NPR, 4/17).
'Muted Praise' From Some AIDS Advocates
The new guidelines received "muted praise" from some HIV/AIDS advocates, the Post reports (Washington Post, 4/18). Mark Isaac, vice president of the Elizabeth Glaser Pediatric AIDS Foundation, lauded the focus on prenatal testing, but he supported upholding programs that give women the right to refuse HIV testing, according to the Journal-Constitution. He said, "We strongly believe the best way to get the maximum number of tests done and to prevent the maximum number of infections is to have a relationship of trust and cooperation between the mother and her health care provider. Once you move to a mandatory situation, we don't believe that level of trust persists" (Atlanta Journal-Constitution, 4/18). Isaac added that he believes the new policy "will save lives" (Sternberg, USA Today, 4/18). Other advocates said that the administration is focusing prevention efforts on the "most politically palatable" group -- infants -- and not on "less appealing" populations, such as injection drug users, according to the Post. Cornelius Baker, director of the Whitman-Walker Clinic in Washington, D.C., said that vertical HIV transmission is "300 cases. What about the 39,700 others?" referring to the 40,000 new HIV cases reported in the United States each year (Washington Post, 4/18). Daniel Montoya, director of governmental affairs for AIDS Project Los Angeles, said, "I think [the plan] is shortsighted in some ways. Unless you are doing comprehensive prevention, in terms of looking at people who are at risk and not just look at those who are already infected, we may have another epidemic on our hands 10 years down the road" (Los Angeles Times, 4/18).
The following groups issued press releases responding to the new plan:
AIDS Action: The group said in a statement that the new strategy "will only be effective it if keeps the door open for continued implementation of prevention and treatment strategies and respects community-based choice in identification of appropriate prevention and treatment options." The release added, "AIDS Action calls on President Bush and his administration to carry forth their commitment to ending the HIV/AIDS epidemic by making HIV treatment services available, accessible and affordable to all Americans who test positive for HIV" (AIDS Action release, 4/17).
AIDS Alliance for Children, Youth & Families: Executive Director David Harvey said that "receiving an HIV diagnosis is a life changing event. ... We cannot give people -- especially pregnant women -- an HIV positive diagnosis without information and counseling. Removing the link between counseling and HIV testing is a mistake." He added, "CDC's change in policy means women at high risk for HIV will be further alienated from the health care system." The group "strongly urge[d]" states to maintain HIV counseling as an "integral part" of HIV testing (AIDS Alliance for Children, Youth & Families release, 4/17).
Beyond AIDS Foundation: The foundation "commended" the CDC and the Bush administration on the new guidelines. Cary Savitch, the foundation's president, said that the strategy was a "small but important first step" in "reversing the course of the HIV epidemic through sound public health policy" (Beyond AIDS Foundation release, 4/17).
Children's AIDS Fund: The new CDC strategy is "based on sound medicine and public health principles," Shepherd Smith, founder and board member of the fund, said, adding, "The bottom line is that these measures will help save lives and limit suffering, which are everyone's objectives involved in the AIDS issue" (Children's AIDS Fund release, 4/16).
Concerned Women for America: The CDC's guidelines will "prolong the lives of those already infected, sharply reduce the number of new infections, and virtually end the tragic spectacle of neonatal infections," CWA President Sandy Rios said in a letter to Gerberding. She added, "True compassion requires that we stop this deadly disease through the most effective means possible" (CWA release, 4/17).
Florida AIDS Action: Executive Director Dr. Gene Copello said that several HIV/AIDS groups have been "waiting for some of these approaches to take shape on a federal level," but he added, "Of course, we have concerns over how these initiatives will be implemented and regret that the CDC did not consult the community while developing these strategies. We encourage the CDC to do so as these programs are implemented" (FLAA release, 4/17).
Medical Institute for Sexual Health: The institute "enthusiastically applauded" the new CDC prevention guidelines. Joe McIlhaney, president and founder of the institute, lauded the CDC for "being dissatisfied with the status quo and for ... announcing dramatic science-based HIV prevention recommendations" (MISH release, 4/17).
San Francisco AIDS Foundation: The "devil will be in the details" of the guidelines released yesterday, Pat Christen, executive director of the foundation, said. While the foundation "strongly agrees with the CDC" on encouraging HIV testing for those deemed at risk, Christen urged the agency to "continue to ensure that HIV testing efforts require the informed consent of those tested." Fred Dillon, the foundation's director of policy and communications, added, "It is irresponsible to increase emphasis on encouraging people to find out their HIV status if we do not simultaneously provide adequate funding for critical HIV treatments and care" (SFAF release, 4/17).
NPR's "All Things Considered" yesterday reported on the new prevention strategy. The segment includes comments from Gerberding, Fenway Community Health Center Director Dr. Stephen Boswell and Fenway social worker Justine Sullivan (Knox, "All Things Considered," NPR, 4/17). The full segment is available online in RealPlayer. This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.