Gov. Gretchen Whitmer addressed the State of Michigan after a plan to kidnap her and other Michigan government officials was thwarted by state and federal law enforcement agencies. She started by saying thank you to law enforcement and FBI agents who participated in stopping this [...]
by Bob Roehr
The Centers for Disease Control and Prevention (CDC) posted an updated HIV Prevention Strategic Plan on its Web site Jan. 3. It “will guide the agency’s HIV prevention efforts for the next three years,” Robert S. Janssen, MD, wrote to state and local officials. Janssen heads up those activities at the CDC.
The document updates a five-year plan covering 2001 to 2005, which has been in limbo for the last two years. The original plan had set a goal of cutting the number of new infections in half.
However, according to current CDC estimates, the number of new infections has not declined at all. And leaked reports of their new estimates, likely to be released later this month, are that the number of new infections may actually have increased, perhaps substantially.
When asked at the CDC prevention conference in Atlanta last December why the original plan did not result in a decrease a the number of new infections, Janssen said, “One of the key elements of that plan was getting the necessary resources to fund what was needed. That did not happen. Resources have stayed fairly level and because of inflation have eroded” in terms of purchasing power.
“There is a strong feeling in the community and among researchers in public health that the scale of HIV prevention efforts has not been at the level yet, is not at the critical mass that is needed to make the impact that is needed,” he said.
In his current letter, Janssen said the “extended plan” includes a short-term goal of reducing new HIV infections by 5 percent per year or at least 10 percent by the end of 2010. It sets a series of 42 specific objectives and lists an even greater number of milestones by which to measure progress.
Given the past history of the earlier plan upon which this extension is based; the two-year lapse until this extension was announced; inadequate resources devoted to HIV prevention and a 19 percent decline in the purchasing power of existing prevention dollars; added to the failure to set dollar amounts that would constitute adequate funding to finance this program, some say there is little reason to treat it seriously. It is the product of a bureaucracy going through the motions in order to check off a box on a “to do” list.
Tom Coates, the former director of Center for AIDS Prevention Studies (CAPS) and now at UCLA, delivered a keynote address at the CDC’s HIV prevention conference in Atlanta in December. He echoed that speech when he said, “What is needed is a comprehensive HIV plan for the U.S. with clear and defined goals, milestones, implementable actions, and milestones. Nothing short of that will do.” In his opinion, the extended plan “does not seem to meet that need.”
Steve Morin, the current director of CAPS at the University of California San Francisco, said, “It’s better to have a plan than not. It is a decent one, thoughtful, and it gives a framework for evaluating progress.”
He added the need for such a plan grew out of a review of early CDC prevention activities that found it difficult to fully evaluate the effectiveness of spending because there was no overarching framework of goals and objectives. That led to creation of the first plan, released in 2001.
Morin said that demonstrated effective prevention activities, such as needle exchange and activities to build self-esteem among young gay men, increasingly ran into political opposition in Congress, beginning in the 1990s. That has led to a shift away from risk reduction and counseling to faith-based and “medicalized” approaches such as prevention for positives and early detection through testing.
CDC alumnus David Holtgrave, now at Johns Hopkins University, said the extended plan “starts with an assumption of relatively flat funding through the next three years and then seeks to determine what they believe might be achievable within constrained resources.”
“Given that there is an HIV infection roughly every 13 minutes in the U.S., HIV prevention is a matter of national urgency. I’d recommend setting a bold evidence-based strategy for reducing new infections by 50 percent or more, and then determining the resource level needed to achieve that public health goal.
Holtgrave and colleagues laid out the framework on how to create such a plan in a commentary in the July, 2007 issue of the American Journal of Public Health.
Ron Stall, another CDC veteran who is now a researcher at the University of Pittsburgh, said, “The HIV Prevention Strategic Plan can’t work without funding support. A plan without funding mechanisms to carry it out is meaningless. I’d imagine that the question of funding for the plan – along with many other pressing issues of great importance to our country – will be left by the Bush administration for the next President to sort out.”
He believes there is adequate money to fund prevention programs if it isn’t squandered on activities “that can be justified only in partisan political terms,” such as “the abstinence only nonsense,” which is funded through the Department of Education. Stall says, “The challenge is to spend it in ways that will actually yield some public health outcomes.”
The HIV Prevention Strategic Plan: Extended Through 2010 can be found at http://www.cdc.gov/hiv/resources/reports/psp/