No Time to Lose Getting More from HIV Prevention (2001) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-10
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We must learn from our past successes, as well as from our failures, in prevention and we must focus prevention efforts on those individuals and communities who are increasingly affected by the epidemic. By the end of 1999, a total of 733,374 AIDS cases and 430,411 AIDSrelated deaths had been reported in the United States (CDC, 2000a)
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As a result of such challenges, the Centers for Disease Control and Prevention requested that the Institute of Medicine convene a committee to review current HIV prevention efforts in the United States, to develop a visionary framework for a national HIV prevention strategy that could significantly reduce new infections, and to suggest the roles that public and private-sector agencies should have within this framework. The Committee examined the available evidence, and received much useful information and advice from federal, state, and local agencies, as well as from community organizations involved in research on HIV prevention and in implementing HIV prevention programs.
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The Committee believes that, for HIV prevention efforts to have maximum impact, there * Although the Committee's charge was limited to examining and providing a visionary framework for HIV prevention in the United States, significant attention must also be directed to improving HIV prevention efforts at the global level and to ameliorating the devastating impact that HIV/AIDS has had in developing nations.
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To reach this goal, a new vision is needed that will improve the way the epidemic is monitored, change how prevention resources are allocated and how activities are prioritized and conducted, foster interactions between the public and private sectors to promote new prevention tools and technologies, and reduce or eliminate social barriers to HIV prevention. This strategic vision is comprised of six elements: · develop an accurate surveillance system, focused on new HIV infections, that can better predict where the epidemic is headed; · allocate prevention resources to prevent as many new HIV infections as possible, guided by principles of cost-effectiveness rather than simply by the number of AIDS cases; · direct prevention services to HIV-infected persons, who often have been excluded from prevention activities, and integrate prevention activities into the clinical setting in order to reach people at high risk of becoming infected; · translate findings from prevention research into action at the community level; · invest in the development of new tools and technologies to expand HIV prevention efforts; and · strive to overcome social barriers and to remove policy barriers that impede HIV prevention.
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The recommended surveillance system would estimate new HIV infections using blinded serosurveys of well-characterized sentinel populations (e.g., drug users in treatment, people attending sexually transmitted disease clinics and tuberculosis clinics, clinics serving women of reproductive age) , surveys that characterize the populations served by those sites, and advanced testing technologies that are able to identify recent HIV infections.
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In addition, individuals at high risk for HIV infection often come in contact with the health care system for services at a variety of different entry points, and each of these clinical settings provides valuable opportunities for delivering HIV prevention services. Thus, the Committee recommends that: Prevention services for HIV-infected persons should be a standard of care in all clinical settings (e.g., primary care centers, sexually transmitted diseases clinics, drug treatment facilities, and mental health centers)
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As a result, the Committee recommends that: Key Department of Health and Human Services agencies that fund HIV prevention research and interventions should invest in strengthening local-level capacity to develop, evaluate, implement, and support effective programs in the community. The Committee further recommends that these agencies invest in research on how best to adapt effective programs for use in community-level interventions and research on what constitutes effective technical assistance for optimal research-to-community transfer of prevention programs; these agencies should also be responsible for the widespread dissemination of the results of this research.
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National leadership is urgently needed to provide a coordinated strategy for effectively overcoming these social barriers in order to capitalize on the unrealized opportunities in HIV prevention. Thus, the Committee recommends: increasing drug abuse treatment funding to levels that are sufficient to provide drug treatment to all those requesting it; removing legal and policy barriers that limit access to sterile drug injection equipment; eliminating congressional, federal, state, and local requirements that public funds be used for abstinence-only education, and that states and local school districts implement and continue to support age-appropriate comprehensive sex education and condom availability programs in schools; and removing policy barriers that hinder the implementation of effective prevention efforts in correctional settings.
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Morbidity and Mortality Weekly Report 46:861-867. Centers for Disease Control and Prevention.
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In this chapter, the Committee discusses the present system and its limitations, the rationale for implementing a surveillance approach to track the incidence of HIV, and the limitations of current HIV surveillance systems in measuring incidence. Further, the Committee recommends a new surveillance approach that can provide population-based estimates of HIV · — nclc ence.
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