No Time to Lose Getting More from HIV Prevention (2001) / Chapter Skim
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Pages 213-227
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From page 213... ...
, 74 AFLA. See Adolescent Family Life Act Africa, HIV incidence in, 105,140 African Americans Medicaid services provided to, 57 rates of AIDS infection among, 143145 Agency for Health Care Quality and Research, spending on HIV/AIDS, 172 Aggregate HIV incidence, estimating, 173 AIDS cases adult/adolescent, by exposure category, 141 and co-occurring conditions, 147-148, 152 geographic distribution of, 145-146 inadequacy of reporting based on, 15 increases in, 1 lag in diagnosis time for, 4, 81n perinatally acquired, 144-145 providers caring for, 55-56 "public health" responses to, 22 in racial and ethnic minorities, 144-145 rates per 100,000 population, 146 and sexual orientation, 2 in women, 142-143 in youth, 143-144
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From page 214... ...
See also HIV prevention investments versus AIDS incidence by state, 32 assessing the cost-effectiveness of, 3235 calculations for, 175-177 at the community level, 39 current allocation of federal, 28-32 at the national level, 3946 optimizing, 44-46 state and local, 3, 46-47 a strategic vision for, 37 using epidemic impact as a measure of success, 35-37 Alternative barrier methods, 83-86 the female condom, 83-84 microbicides, 84-86 "America Responds to AIDS" (ARTA) , 158 American Academy of Pediatrics, 118 American Foundation for AIDS Research, 90 INDEX American Indians, HIV prevention programs for, 171 American Journal of Public Health, 173 Anal intercourse, male condom use during, 36 Annual infections prevented cost-effectiveness versus proportional allocation, 43 impact of investing in better, more expensive programs, 45 percentage improvement, 44 Antimicrobial therapies, advances in, 7 Antiretroviral therapies, 86-87 advances in, 2, 7,14 HIV-infected persons receiving, 51 nevirapine, 34, 156 optimizing patient adherence to, 53-54 Public Health Service Task Force recommendations for use of, 34 zidovudine, 34,142, 156 ARTA.
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From page 215... ...
, 2, 11, 34 215 allocation of HIV prevention funds versus AIDS incidence by state, 32 intervention /program implementation, 164-165 leading role played in HIV prevention, 26, 47 policy, 165 position on HIV testing, 55 program evaluation, 165 publicly funded sites of, 55n recommendations to, 59 research under, 68, 165 spending on HIV/AIDS, 164-165 studies by, 52-53 surveillance by, 15, 165 syphilis elimination plan, 62 technical assistance, 165, 186 Changes in Medicaid and Ryan White Care Act programs needed to encourage HIV prevention, 58-63 Changes in the epidemic, 139-151 AIDS trends in the United States, 139148 demographics of, 142-146 HIV incidence and prevalence, 148149 Changes needed to encourage HIV prevention, 58-63 encouraging HIV prevention in CARE Act programs, 61-63 financing options for Medicaid coverage, 58-61 Characteristics of Reputationally Strong Programs Project, 69 health care settings utilized by, 56 programs for under the Ryan White CARE Act of 1990, 170 Clinical care for HIV-infected persons financing, 56-58 programs that provide, 55-58 Clinical settings, 50-67 changes in Medicaid and Ryan White Care Act programs needed to encourage HIV prevention, 58-63 DHHS-wide policies to encourage integration of prevention into clinical care, 63 programs that provide clinical care to HIV-infected persons, 55-58 using for prevention, 6, 51-55
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From page 216... ...
See Center for Substance Abuse Prevention CSAT. See Center for Substance Abuse Treatment Current allocation of federal HIV prevention funds, in allocating resources, 28-32 Current national AIDS surveillance system, 15 D Data gathering activities, 180-193 Community Planning Leadership Summit, 180-185 problems with expanding, 186 requests for public comment, 185-190 site visits to state health departments 190-193 Data needs, requests for public comment on, 185-186 Deaths, estimates of, 141 Demographics of the AIDS epidemic, 14, 142-146 cases in racial and ethnic minorities, 144-145 cases in women, 142-143
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From page 217... ...
, 56 Description and mathematical statement of the HIV prevention resource allocation model, 173-179 allocating resources for HIV prevention, 175-177 the costs of HIV prevention programs, 174-175 estimating aggregate HIV incidence, 173 estimating the efficacy and reach of HIV prevention programs, 174 Detecting HIV antibodies, rapid testing methods for, 80-83 DHHS. See Department of Health and Human Services Diabetes, 190 217 Diagnosis time for AIDS cases, lag in, 4, 81n Discharge planning in correctional settings, 121-123 for U.S.
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From page 218... ...
See Food and Drug Administration Federal Bureau of Justice, studies by, 124 Federal drug control spending, 111 Federal HIV prevention funds, current allocation of, 28-32 Federal Regulation of Methadone, Inn Federal spending on HIV/AIDS, 162-172 additional technical assistance needed in HIV prevention activities, 192 Agency for Health Care Quality and Research, 172 Centers for Disease Control and Prevention, 164-165 Department of Health and Human Services, 164-172 for fiscal year 1995-1999, domestic, 163 Food and Drug Administration, 170171 Health Care Financing Administration, 171 Health Resources and Services Administration, 168-170 Indian Health Service, 171 National Institutes of Health, 165-167 overview of, 162-164 Substance Abuse and Mental Health Administration, 167-168 INDEX Fee-for-service, Medicaid coverage for, 5960 Female condom use, 83-84 Financing options for Medicaid coverage, 58-61 Medicaid fee-for-service, 59-60 Medicaid managed care organizations, 60-61 Food and Drug Administration (FDA) recommendations concerning tests, 34, 81-82 regulatory role of, 110-111,170 spending on HIV/AIDS, 170-171 Funding HIV prevention.
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From page 219... ...
, 56 HIV Cost Study, 168 HIV disinfection, use of bleach for, 125 HIV education, harm reduction, and discharge planning programs, in U.S. adult correctional systems, 122 HIV incidence estimation changes in, 148-149 population-based, in tracking the epidemic, 19-23 HIV-infected persons categorization of by DHHS, 108 complacency among, 1 extending prevention efforts to, 50 programs that provide clinical care to, 55-58 receiving antiretroviral therapy, 51 HIV infections, allocating resources for prevention of new, 5-6,11 changes needed to encourage, 58-63 defining, 27n encouraging in CARE Act programs, estimating the efficacy and reach of, 174 integrating early in health professionals' training, 54 leading role played by the Centers for Disease Control and Prevention in, 26 programs for Native Americans, 171 resource allocation for, 38-46 rethinking, 11-13 unrealized opportunities for improving, 193 HIV Prevention Community Planning Process, 76 HIV Prevention Evaluation initiative, 75n HIV prevention funds, CDC allocation of, versus AIDS incidence by state, 32 HIV prevention in correctional settings, 120-128 discharge planning, 121, 123 drug abuse treatment, 124-125 harm reduction programs, 125-128 HIV prevention education, 123 HIV Prevention Initiative for Youth and Women of Color, 168 HIV prevention investments, 33 development of new tools and technologies for, 7-8 strategic vision in allocating resources, 26, 37 HIV prevention research dissemination, examples of, 70-71 HIV Prevention Science Initiative, 166 HIV prevention strategies description and mathematical statement of resource allocation model for, 173-179 examples of research dissemination, 70-71
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From page 220... ...
See HIV I IDUs. See Injection drug users Immunofluorescence assay, 81n Impact of investing in better, more expensive programs, on preventing annual infections, 45 Implementation of Centers for Disease Control and Prevention programs, 164-165 of HIV prevention programs, 192-193 of needle exchange programs, 34-35 removing obstacles to, 13 requests for public comment on, 188189 Improving HIV prevention, unrealized opportunities for, 193 Incidence estimation, 141 changes in HIV, 4, 148-149 declines in, 14 population-based, in tracking the HIV epidemic, 19-23 Indian Health Service, spending on HIV/ AIDS, 171 Infants, programs for under the Ryan White CARE Act of 1990,170 Infected persons complacency among, 1 extending prevention efforts to, 50-51 programs that provide clinical care to, 55-58 Infections.
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From page 221... ...
, 75, 165 National Institutes of Health (NIH) , 28, 165-167, 182 Consensus Panel on Interventions to Prevent HIV Risk Behaviors, 119, 152 nonvaccine prevention research under, 166-167 spending on HIV/AIDS, 165-167 vaccine research under, 68, 167 National level resource allocation for HIV prevention, 39-46 base scenario, 42 optimistic scenario, 42 pessimistic scenario, 42 National Research Council (NRC)
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From page 222... ...
, 119 INDEX Pessimistic scenario, at the national level of resource allocation, 42 "Physician Delivered Intervention for HIV+ Individuals," 53 Planning effective HIV prevention programs additional information needed for, 192 barriers encountered, 193 Policy issues in Centers for Disease Control and Prevention programs, 165 explicit goals of, 11-12 Population-based HIV incidence estimation, in tracking the epidemic, 19-23 Poverty, as a social barrier, 98-100 Presidential Advisory Council on HIV/ AIDS (PACHA) , 69, 74 in adults, estimates of, 141 changes in HIV, 148-149 Prevention, 6, 51-55 effectiveness of, 11 "missing link" in, 187 of new HIV infections, 5-6,153-155 of perinatal transmission of HIV, 34 Prevention budgets, 38-39 Prevention education, in correctional settings, 123 Prevention Marketing Initiative, 158 Prevention portfolio, 152-161 behavioral interventions, 155-156 biomedical and technological interventions, 156-157 interventions associated with the treatment of co-occurring conditions, 156 societal interventions, 157-158 Prevention research, requests for public comment on translating into practice, 187 Prevention Research Synthesis (PRS)
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From page 223... ...
, measure of effectiveness, 38n R Race counseling, testing, referral, and partner notification by, 30 health education and risk reduction by, 30-31 proportion of AIDS cases by, 145 Racial minorities, AIDS cases in, 144-145 Racism, as a social barrier, 98-100 Rapid testing methods, for detecting HIV antibodies, 80-83 Rates of AIDS cases, per 100,000 population, 146 Rationale for a national system of HIV surveillance, in tracking the epidemic, 16 Re-infection, with drug-resistant HIV, 52 223 Reach of HIV intervention programs, 40, 174-175 Receptive anal intercourse, male condom use during, 36 Recommendations for allocating prevention resources, 56,37 for a CDC-created, population-based surveillance system, 4-5 to the Centers for Disease Control and Prevention, 59 for collaboration among federal agencies, 114 for congressional policy making, 120 for creating a surveillance system, 1718,22 general, 191-193 to the Health Care Financing Administration, 59 from The Hidden Epidemic, 101 for HIV prevention in correctional facilities, 126-127 for investing in local-level research and interventions, 6-7, 77 for investing in products and technologies linked to HIV prevention, 7-8, 91 for legalizing injection equipment, 116 for overcoming social barriers to HIV prevention, 8 for providing prevention services as standard for all HIV-infected persons, 6, 63 of Public Health Service Task Force for use of antiretroviral drugs, 34 Referrals, by race and ethnicity, 30 1990 Report of the Commission on Health Research for Development, 90 Reporting issues, 148 Requests for public comment, 185-190 on coordination and implementation of programs, 188-189 on data needs, 185-186 on opportunities and barriers, 189-190 on program evaluation, 187-188 on technical assistance, 186 on translation of prevention research into practice, 187 Research barriers to effective technology transfer at the community level, 72-74
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From page 224... ...
test, 81-82 Site visits to state health departments, 190193 additional information needed for planning, implementing, or monitoring HIV prevention programs, 192 additional technical assistance needed from the federal government to support HIV prevention activities, 192 barriers encountered to planning or implementing effective HIV prevention programs, 193 evaluating HIV prevention programs for workability, 192 potential new partnerships or alliances health departments should pursue, 193 prioritizing and selecting HIV prevention strategies for implementation, 191 unrealized opportunities for improving HIV prevention, 193 Social barriers, 3, 12, 98-128 access to drug abuse treatment, 106-116 access to sterile drug injection equipment, 114-116 comprehensive sex education and condom availability in schools, 116-120 HIV prevention in correctional settings, 120-128 lack of leadership, 104-105 misperceptions, 103-104 poverty, racism, and gender inequality, 98-100 the sexual "code of silence," 100-101 stigma of HIV/AIDS, 101-103 Social Security Disability Insurance (SSDI) , Societal interventions, to prevent HIV infection, 157-158 Special Projects of National Significance, established under the Ryan White CARE Act of 1990,123,170 Spermicides, 85
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From page 225... ...
See Supplemental Security Income Standard Metropolitan Statistical Areas, 41, 173 State health departments, 58-59,190-193 additional information needed by for planning, implementing, or monitoring HIV prevention programs, 192 additional technical assistance needed by from the federal government to support HIV prevention activities, 192 barriers encountered by to planning or implementing effective HIV prevention programs, 193 evaluations of HIV prevention programs for workability by, 192 potential new partnerships or alliances for, 193 prioritizing and selecting HIV prevention strategies for implementation by, 191 unrealized opportunities for improving HIV prevention by, 193 State resource allocation, support for, 4647 States and territories, grants to under the Ryan White CARE Act of 1990,169 "The States of the HIV/AIDS Epidemic," 139n Statewide Community HIV Evaluation Project, 75n Statistical modeling, 19 STDs. See AIDS; HIV Sterile drug injection equipment access to, 114-116 policy recommendations concerning, 13 Stigma of HIV/AIDS, as a social barrier, 3, 97, 101-103 Strategic vision for HIV prevention investments in allocating resources, 37 elements of, 4 Stroke, 190 Substance Abuse and Mental Health Administration (SAMHSA)
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From page 226... ...
See Department of Veterans Affairs Health Care System Vaccine research under the National Institutes of Health, 167 return on investment issue, 88 Vaccine Research Center, 167 Vaccines, 87-89 advances in, 7 W Western Blot test, 81n, 82 WHO Ad Hoc Committee on Health Research, 90 William and Flora Hewlett Foundation, 90 Women AIDS cases in, 142-143 funding programs aimed at, 46,189 health care settings utilized by, 56 programs for under the Ryan White CARE Act of 1990,170 1999 Work Group Report on HIV Prevention Activities, 74 Workability, evaluating HIV prevention programs for, 192
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From page 227... ...
INDEX World Bank, 90 Youth 227 programs for under the Ryan White CARE Act of 1990,170 y AIDS cases in, 143-144 health care settings utilized by, 56 z Zidovudine (ZDV)
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