Effective HIV Prevention Programs in the U.S.

 

 

Persons at High Risk for Contracting HIV

 

“The first HIV-prevention programs in the United States were grassroots measures initiated in 1982 predominantly by homosexual men in San Francisco, California, and New York City (2). These and other early HIV-prevention activities primarily were designed to increase AIDS awareness, reduce unfounded fears about transmission, and provide basic information regarding symptoms, likely transmission routes, and risk-reduction strategies.

Early CDC activities included establishment of the National AIDS Information Line (1983) and National AIDS Clearinghouse (1987), institution of the nationwide America Responds to AIDS public information campaign (1987), and distribution of Understanding AIDS (1988), a brochure prepared in consultation with U.S. Surgeon General C. Everett Koop; this was the first mailing regarding a major public health problem that was delivered to every residential mailing address in the United States (3). CDC programs during the mid- to late 1980s addressed high-school and college-aged populations, persons at increased risk for HIV, racial and ethnic minority populations, perinatal transmission, and health-care workers (3). These programs increased basic knowledge about HIV transmission and prevention, reduced risk behavior within populations at high risk for infection, and decreased negative attitudes toward persons living with HIV/AIDS (4).

However, as important as these gains were, they were not sufficient to motivate behavior change among some persons at high risk for HIV infection. More intensive, targeted interventions were developed, including the five-city CDC AIDS Community Demonstration Projects (1989), which produced effective, community-level interventions for difficult-to-reach populations that led to increased condom use with main and nonmain sex partners (5). A wide range of behavioral intervention strategies, operated at individual, small-group, and community levels, and complemented by structural interventions and medical/technological advances, has been implemented for persons at high risk for HIV infection (Table 1) (4).

Behavioral interventions were observed to substantially reduce HIV risk while remaining cost effective or cost saving for a wide range of populations at high risk (4). The CDC HIV Prevention Research Synthesis Project has conducted meta-analyses of data from scientifically rigorous intervention trials since 1996. These analyses have determined that behavioral interventions substantially reduce sexual risk among young adults, men who have sex with men (MSM), heterosexual men and women, and drug users (6–9). More than 50 interventions for populations at high risk have been identified that meet stringent criteria for efficacy and scientific rigor (10–12). A growing number of these evidence-based interventions have been packaged for use in local HIV-prevention programs (13,14). These packages, or kits, and training on how to use them are available through the CDC Diffusion of Effective Behavioral Interventions (DEBI) project (Table 2) (15). In addition, CDC supports a wide range of other activities designed to build the capacity of local HIV-prevention providers and their organizational infrastructures (Table 3).”   Read more:  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5521a4.htm 

On Monday, February 28, Dr. Jonathan Mermin gave a plenary presentation at the 18^th Conference on Retroviruses and Opportunistic Infections (CROI) in Boston. Dr. Mermin is the Director of the Division of HIV/AIDS Prevention at the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. His talk was titled The Science and Practice of HIV Prevention in the U.S . We encourage you to view and/or listen to his presentation, which includes slides and data.

 

 

Dr. Ronald Valdiserri had the opportunity to talk with Dr. Mermin after his presentation, and we wanted to share their conversation with you. Please enjoy the following podcast and give us your feedback.

To watch other presentations from CROI, visit the conference Webcast Sessions page .

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By Miguel Gomez, AIDS.gov Director

 

 

Related article, CDC: http://www.cdc.gov/std/hiv/STDFact-STD-HIV.htm

 

 

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A Celebration of Women