Validates amfAR’s Long-Standing Prevention Strategy

On September 27, the Institute of Medicine (IOM) of the National Academy of Sciences issued a much anticipated blueprint for future HIV/AIDS prevention efforts. Titled "No Time To Lose: Getting More from HIV Prevention," the report was authored by the IOM’s Committee on HIV Prevention Strategies in the United States, which includes leading prevention experts and is chaired by Harvey V. Fineberg, M.D., M.P.P., Ph.D., Provost of Harvard University. The study was sponsored by the U.S. Centers for Disease Control and Prevention (CDC).

The scientists were unsparing in their evaluation of current U.S. prevention efforts. As Dr. Fineberg observed, "The number of new infections remains unacceptably high [and] new AIDS cases have increased considerably among women, minority populations, and young people. Although new AIDS cases have declined among men who have sex with men, some metropolitan areas are seeing an increase in HIV infection rates [among] this population. While new antiretroviral therapies have improved the health and prolonged the lives of those who are infected, these drugs also have contributed to a dangerous sense of complacency."

In drawing up a prevention plan, the committee adopted the goal of averting as many new HIV infections as possible using the resources currently available. Unfortunately, it was found that current public health strategies are neither cost-effective nor deliver prevention information and services to those at the greatest risk of HIV. To redress these and other problems, the committee articulated the following key strategies:

• Improved epidemiological surveillance: Current surveillance focuses primarily on reported AIDS cases, but AIDS diagnosis in the U.S. lags approximately 10 years behind HIV infection. Thus, the current surveillance system shows where HIV has been, not where it is now or where it is going. In order to accurately assess HIV’s impact, the committee recommends the use of "sentinel" surveys to monitor specific locations and sub-populations, e.g., drug users in treatment, people attending sexually transmitted disease clinics, etc., using tests that can indicate recent HIV infections.
• Improved allocation of prevention resources: Most prevention funds are currently allocated according to the number of reported AIDS cases in specific populations or regions. As noted above, however, AIDS prevalence does not reflect current prevention needs. The committee recommends directing prevention efforts to populations at high risk of infection, and using interventions of proven efficacy and cost-effectiveness, which could prevent 20% to 30% more infections than the current allocation of HIV prevention funds.
• Improved prevention services for those who are HIV-infected: People with HIV/AIDS should be more consistently educated and encouraged to protect others. In addition, many individuals at high risk for HIV infection come into contact with the health care system, and prevention outreach for such individuals should be integrated into the clinical setting.
• Improve effectiveness of community-based prevention programs: There are a variety of community-based programs that provide prevention education. In order to identify which are most cost-effective, we need to evaluate them scientifically and then translate the results of such studies into concrete recommendations.
• Develop vaccines and microbicides: The report recommends that the National Institutes of Health place high priority on the development of anti-HIV microbicides and vaccines and that funding be increased accordingly.
• Overcome social barriers to effective policy: Social and cultural attitudes towards sexual activity and drug use have tended to foster shortsighted policies, such as insufficient funding for drug abuse treatment, limited access to sterile syringes, and requirements that public funds be used for "abstinence only" education, which impede the implementation of proven HIV prevention interventions.

The overarching theme of the committee’s recommendations is that HIV/AIDS prevention policy should be based on sound scientific principles and seek to protect everyone at risk of HIV infection. amfAR was among the very first national organizations to articulate and promote such a comprehensive science-based prevention philosophy and continues to advocate an effective national prevention strategy, which would include removal of the current ban on federal funding for syringe exchange programs and reform of existing laws regarding the possession and sale of syringes. Copies of the IOM’s report are available online; to view, click here.