# Presentation: 731384

## Advancing HIV Prevention: New Strategies for a Changing Epidemic

- Ronald O. Valdiserri, M.D., M.P.H.
- Centers for Disease Control and PreventionPACHA August 7, 2003

**Notes:**
I want to start by acknowledging the leadership role that the CBC and the other minority caucuses have taken on to fight the HIV epidemic in the United States. HIV has disproportionately affected communities of color since the 1980s, and the impact on these communities has worsened over time. It was critical for the CBC in 1999 to begin the funding stream for HIV prevention that has become known as the Minority AIDS Initiative. 

## AIDS Cases and Deaths

- Reported 1981 – 2002, United States

## Estimated Incidence of AIDS, Deaths, and Prevalence, by Year of Diagnosis/Death, United States, 1981–2002* 

- Estimated Incidence of AIDS, Deaths, and Prevalence, by Year of Diagnosis/Death, United States, 1981–2002*****

- *Adjusted for reporting delays

- 81

- 83

- 85

- 87

-  89

-  91

-  93

-  95

-  97

-  99

- 82

- 84

- 86

- 88

-  90

-  92

-   94

-  96

-  98

-  00

- 01 02

- Incidence

- Deaths

- Prevalence

- Number of Cases/Deaths
- (Thousands)

- Prevalence
- (Thousands)

- Year

## Sexual Behaviors of 1,606 HIV-Infected Persons* Interviewed in SHAS, 2002

**40%**

**27%**

**15%**

**14%**

- <1%

***** Sexual behavior in the last 12 months among persons
-    who knew their serostatus for 12 months or more.

## Findings from Syphilis Outbreak Investigations2000 - 2001

- Findings from Syphilis Outbreak Investigations2000 - 2001

| Characteristic | Miami | New York City | Los Angeles |
| --- | --- | --- | --- |
| No. of cases |   50* | 111** |   171 |
| Median age, yrs |  33 | 34 |    35 |
| Race/ethnicity |  |  |  |
|     White |     27% |   41% |       38% |
|     Black |     10%  |   32% |       14% |
|     Hispanic |     59% |   22% |       44% |
| Known HIV+ |     43% |    53% |       59% |

-   *January through June 2001 only.
-  **Primary and secondary syphilis only.

## Awareness of Serostatus among 

- Number HIV infected       850,000 - 950,000
- Number unaware
- of their HIV infection  	180,000 - 280,000

- Awareness of Serostatus among
- Persons with HIV, United States

## Late TestingSurveillance Data*, 1994 -1999

- 104,780 persons diagnosed with HIV
- 43,089 (41%) with AIDS within a year after HIV-positive test

-   Source: Neal J. 9th CROI, 2002.

- * 25 states with integrated HIV/AIDS surveillance.

## Perinatally Acquired AIDS Cases by Year of Diagnosis, 1981 – 2002, United States

## What is the New Initiative?

- “Advancing HIV Prevention” is aimed at reducing barriers to early diagnosis of HIV infection and increasing access to and utilization of quality medical care, treatment, and ongoing prevention services for those living with HIV.
- Goal is to reduce HIV transmission.
- A component of CDC’s overall prevention portfolio

## Strategies of the Initiative

- Four priority strategies:
- Make voluntary HIV testing a routine part of  medical care
- Implement new models for diagnosing HIV infections outside medical settings
- Prevent new infections by working with persons diagnosed with HIV and their partners
- Further decrease perinatal HIV transmission

**Notes:**
What are the strategies of the new initiative? There are 4 and they consist of 

## Advancing HIV Prevention is an Important Component of CDC’s Overall Approach to HIV Prevention

- Continue to support efforts to keep negative people healthy
- Continue to fund community-based organizations (CBOs) – especially those serving minorities
- Continue to rely on behavioral prevention approaches
- Continue to support community planning
- Continue to support voluntary testing

## Advancing HIV Prevention: Recent Milestones

- Publication of “Incorporating HIV Prevention into the Medical Care of Persons Living with HIV” (7/18/03)
- Meeting of medical & nursing associations (7/22/03)
- HDs required to make PLWHAs highest priority for prevention services (not the only priority)
- Demonstration projects: currently soliciting

## Advancing HIV Prevention: Recent Milestones (cont’d)

- Publication of Interim Technical Guidance for Grantees (7/03)
- Revised CBO announcement: increased emphasis on early diagnosis, entry into care and prevention for positives (pending)
- Consultation with HIV-positive communities (8/03)
- Procurement of rapid test/training development

## Slide 14

## Monitoring/Tracking the New Initiative

- Incorporate evaluation in each demonstration project
- National behavioral surveillance and HIV incidence surveillance systems
- New performance indicators for state and local health departments and CBOs

## CDC’s Domestic HIV Program

- 65 HIV prevention awards through state and local health departments
-  	approximately 900 indirectly funded CBOs

- 344 direct awards to nongovernmental organizations
-  	214 CBOs funded

- 61 surveillance grantees
- 106 prevention and research awards to research institutions and academic centers

## FY 2002 CDC HIV/AIDS Budget by Race/Ethnicity (*Domestic Only)

-    Note:** **Percentages have been rounded.
** ******* A project/study conducted in the U.S. and/or their territories whose    primary focus is domestic HIV/AIDS. Does not include international activities.
-    Approx. $730.5 M of total FY 02 budget ($890.6 M).