New CDC Rules on AIDS Education Funding Might Reduce Effectiveness of HIV Prevention Materials, Some Advocates Say
Proposed guidelines from CDC for federally funded HIV/AIDS education efforts might reduce the effectiveness of HIV prevention materials and "impede efforts to prevent the disease," according to some HIV/AIDS advocates and educators, the Boston Globe reports. The agency proposed the guidelines with "little fanfare" in June in an effort to "ensure that appropriate prevention messages reach people who need to hear them most" and "increase accountability" for the more than $227 million annually that is given to local organizations for HIV/AIDS education and prevention, according to the Globe. However, CDC's "desire to increase oversight" of the funding has generated "concern" among advocates, the Globe reports. Current CDC regulations require that members of target audiences and local panels of people familiar with how HIV is transmitted approve federally funded prevention materials. The new rules also propose that materials must be approved by state or local public health authorities, according to the Globe. The proposed regulations are the "legacy" of former Rep. Tom Coburn (R-Okla.), who co-chairs the Presidential Advisory Council on HIV and AIDS and says that HIV-positive people should "refrain from all sexual activity," the Globe reports. Coburn also advocates abstinence-only education as the only "100% effective method" for preventing the transmission of sexually transmitted diseases, including HIV, according to the Globe.
Effectiveness of Condoms
The proposed guidelines also require that HIV/AIDS education materials "stress the importance" of abstinence, the Globe reports. A CDC fact sheet on condoms lists abstinence as the first recommendation of HIV prevention. "The surest way to avoid transmission of [STDs] is to abstain from sexual intercourse or to be in a long-term, mutually monogamous relationship with a partner who has been tested and you know is uninfected," according to the fact sheet. However, studies concerning abstinence-based prevention methods have produced "conflicting findings," according to the Globe. Although some studies show that abstinence pledges taken by teenagers might contribute to decreased teen pregnancy rates, other studies show that adolescents who take such pledges are just as likely to contract STDs as adolescents who do not.
"In the absence of an HIV vaccine, really the most effective method we have for preventing HIV is the condom," Elizabeth Miller, who works at a clinic run by Massachusetts General Hospital, said, adding, "To obfuscate that and to make the issue cloudy really is of no benefit for prevention efforts." Moreover, the proposed review process will be "additionally burdensome," according to Kevin Cranston, the acting chief of the HIV/AIDS Bureau in the Massachusetts Department of Public Health. "When you're talking about a disease transmitted through sexual activity and the use of drugs, some of the materials used to reach folks will be a little bit edgy [and] will need to be very direct," Rebecca Haag, executive director of AIDS Action Committee of Massachusetts, said. "The proposed regulations as currently written could have a chilling effect on our ability to prevent the spread of HIV and AIDS," she added. However, a CDC spokesperson said the agency has received complaints about whether prevention materials are "encouraging sexual activity" and if grants were being used for their intended purposes, according to the Globe. "We want to make sure our dollars really contribute to preventing HIV infections," Dr. Ed Thompson, chief of public health practice at CDC, said. Dr. Margaret Scarlett -- who worked on HIV policy, programs and research at CDC until 2001 -- said that the proposed regulations are part of an effort to "introduce political and social ideology into public health initiatives," the Globe reports. "In conversations with friends and colleagues, they're saying the distinctions between science and ideology are not being made," Scarlett said, adding, "It's discouraging for seasoned public health officials who are trying to serve the public's interest who find themselves in a position now where they can't, and it's created a level of frustration for friends and colleagues that for some is untenable" (Smith, Boston Globe, 9/20).