HIV PREVENTION IN THE UNITED STATES MUST BE SCALED UP
“Either we choose to get used to HIV/AIDS…to accept that it is a permanent feature of society…to be satisfied with lengthening lives instead of saving them. Or we decide to double our efforts and start bringing the number of new infections down.”
Kathleen Sebelius, Secretary of the Department of Health and Human Services
You may download a PDF of this article here: HIV Prevention Advocacy Coalition – Prevention Document Updated 031011
Every nine and a half minutes, a person in the U.S. is newly infected with HIV. Every hour, one of them is a young person under the age of 25 and, in 2006, young adults and teens ages 13–29 accounted for 34% of new HIV infections that occurred that year, the largest share of any age group. According to the Centers for Disease Control and Prevention (CDC), men who have sex with men (MSM) accounted for 72 percent of reported HIV/AIDS diagnoses among men in 2006—the most common transmission category for HIV infection. The rates of HIV infection among gay men and other MSM are more than 44 times higher than rates among heterosexual men and more than 40 times higher than women. African Americans continue to represent nearly half (49 percent) of all new cases and are nearly eight times more likely than whites to be HIV positive. Despite comprising only 15 percent of the United States population, Latinos are almost three times more likely than whites to be HIV positive. Women of color represent the majority of new HIV and AIDS cases among women. Black women are 15 times more likely and Hispanic women four times more likely to be HIV positive than white women.
These startling facts highlight the urgent need for a renewed investment on our national response to prevent HIV. Sadly, HIV/AIDS continues its track towards being one of the deadliest epidemics in human history, but prevention makes up only 3% of federal HIV/AIDS spending. HIV prevention is effective, but efforts must be scaled up. Amidst rising infection rates and shrinking state budgets, increased federal funding for HIV-prevention programs and services that facilitate HIV prevention is more vital than ever. The HIV/AIDS epidemic remains a severe and worsening public health crisis in the United States, devastating communities nationwide. Through our national investment, 1.5 million HIV infections have been averted since the start of the epidemic. But with over 56,000 new infections every year, we must do better. The lifetime cost of treating those 56,000 infections is approximately $9.5 billion. If we prevent 240,000 new infections by 2020, the U.S. could save $40.5 billion. By adequately investing in HIV prevention and services that facilitate HIV prevention, we can improve the health of all Americans, hold the line on rising health care costs, and maintain a healthy and productive national workforce.
AT A GLANCE: WHAT IS COMPREHENSIVE HIV PREVENTION?
In addition to addressing underlying biological and socio-economic determinants of HIV risk and transmission, HIV-prevention efforts must reduce risk behaviors among HIV-positive persons and reduce or eliminate behaviors among HIV-negative persons that put them at risk for HIV infection.
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RECLAIMING U.S. HIV PREVENTION: WHAT CAN WE DO BETTER?
With federal HIV prevention funding being relatively flat funded in recent years, and even receiving cuts in some years, state and local prevention programs have been stunted. Combined with dwindling support on the federal level, the current state and local fiscal crises have had a detrimental impact on prevention programs. The political climate has created new opportunities for evidence-based and scientifically sound policies to be promoted. A complete shift to a comprehensive paradigm of HIV prevention in the U.S. requires strong leadership, transparency, accountability, interagency coordination, and a government commitment to a full range of scientifically sound prevention tools, technologies, and outcome measures. As work to implement the National HIV/AIDS Strategy, we must prioritize prevention and invest adequate resources in these efforts.
INVEST MORE RESOURCES IN HIV/AIDS PROGRAMS
Fully fund CDC Division of HIV/AIDS Prevention. Congress should immediately move to increase funding for domestic HIV prevention programs. Sufficiently funding the CDC will have a substantial impact on the epidemic. Significant increases would strengthen prevention programs, surveillance, testing, counseling, and outreach to high-risk populations.
Fund comprehensive sexuality education in schools. Congress should fund age-appropriate, medically accurate, evidence-based, comprehensive sexuality education programs, including HIV-prevention interventions, which discuss abstinence, contraception, and other life skills. Congress should expand the Teen Pregnancy Prevention Initiative to include HIV and STD prevention and comprehensive sex education should be integrated into reauthorization of the Elementary and Secondary Education Act.
Increase HIV testing programs and coverage for HIV testing. Over 20% of people living with HIV are not aware of their HIV status. People who are HIV positive and are knowledgeable of their HIV status are less likely to transmit the virus to others. Payers such as Medicaid, Medicare, and private insurance should cover routine HIV testing.
Fully fund HIV/AIDS research. The need for prevention research is critical given that the rates of new HIV infections outpace the ability to get people into treatment. Greater investment must be put into developing effective behavioral and biomedical strategies, including microbicides and vaccines.
Fully fund prevention of mother-to-child transmission (PMTCT) programs. One of the greatest achievements of HIV prevention in the U.S. is reducing mother-to-child transmission of HIV. This unqualified public health success story can only be maintained and improved upon through sustained efforts and sufficient funding.
Increase funding for Housing Opportunities for People with AIDS (HOPWA) and other housing programs. Studies show that over half of people living with HIV/AIDS (PLWHA) are likely to need housing assistance during their illness. Stable housing helps PLWHA access needed health and prevention services and maintains their treatment regimen, thereby reducing their potential to infect others.
Fully fund the Substance Abuse and Mental Health Services Administration (SAMHSA). Given the link between mental health problems, substance abuse, and HIV, it is crucial these issues be addressed as part of comprehensive HIV prevention and treatment.
Fund federal syringe exchange programs. There is overwhelming evidence that syringe exchange programs dramatically reduce rates of HIV infection, do not increase drug use, and are an effective link to drug treatment programs.
Fully Fund CDC Division of STD Prevention. Congress must significantly scale up investments to STD prevention and control efforts in state and local health departments. An understanding of the strong epidemiological link between HIV and other STDs is critical to developing effective HIV-prevention strategies. Better program coordination between HIV- and STD-prevention efforts at the national, state, and local levels is also needed.
CREATE NEW POLICIES THAT PROMOTE COMPREHENSIVE HIV PREVENTION
Fully fund and support the National HIV/AIDS Strategy. Through the development of the National HIV/AIDS Strategy, there is opportunity to make great strides in HIV prevention and prevention should be prioritized. To ensure that the strategy is effectively implemented, Congress must support these measures through full funding and legislation.
Encourage cross-agency integration of HIV services into already existing public health programs. Coordination of HIV Prevention programs across government agencies, such as CDC, SAMHSA, NIH, and HRSA would allow for greatest transparency and flexibility in establishing and sustaining effective HIV-prevention programs.
Increase targeted prevention interventions for communities in need. Certain communities are disproportionately affected by HIV/AIDS. Resources are required to create and strengthen targeted programs, develop new interventions, and to enhance the ability of communities to develop, implement, and evaluate home-grown evidence-based interventions for specific populations.
Implement comprehensive HIV/AIDS prevention programs in prisons. The HIV epidemic within corrections settings poses a large public health threat. Incarcerated individuals need comprehensive HIV programs including education, voluntary counseling and testing, condom distribution, treatment, and linkages to HIV services while serving their sentence and upon release.