BY Advocate.com Editors
December 12 2003 12:00 AM ET
APLA paper calls for a comprehensive federal HIV prevention approach
AIDS Project Los Angeles on Thursday announced the publication of "Changing How We Think: HIV Prevention Policy in the U.S.," a white paper outlining the current state of efforts to reduce HIV infections in the United States and providing recommendations for a new, comprehensive approach to future HIV prevention work. The document's authors suggest that despite public scrutiny and criticism, HIV prevention efforts in the United States have resulted in the decrease in HIV incidence from its peak of 161,000 new annual infections in 1984 to the current estimate of 40,000 new infections annually. However, with HIV infection rates stable and sexual risk-taking among certain groups on the rise, there is a danger that a "defensive, overly medicalized, and inadequately researched public-health response" by the Centers for Disease Control and Prevention and other federal agencies could hamper efforts to lower those rates. Especially risky may be the government's shift in focus away from traditional prevention programs to emphasize HIV antibody testing outreach and efforts to keep HIV-positive people from exposing others to the virus, according to the report.
"The CDC initiative is simply not comprehensive enough," said George Ayala, APLA director of education and principal author of the report. "It does not address persistent disparities in access to health care and treatment, and it is silent on the significant stigma associated with HIV/AIDS that still exist in many communities. It overlooks the needs of gay men of color and does not identify funding sources for providing care and treatment services to all persons newly diagnosed with HIV."
The APLA paper calls for the adoption of varied, multilevel approaches beyond the twin emphases on HIV testing in the medical setting and prevention case management for people living with HIV/AIDS recommended by the CDC. It calls for addressing addiction issues as a central concern for HIV prevention, for the protection of local control over how HIV prevention strategies are developed and prioritized, and for the targeting of HIV prevention efforts to those most at risk for HIV exposure. "The danger lies in supporting a 'one size fits all' approach to reducing infections," says Craig Thompson, APLA executive director. "Prevention in this country has worked. For it to continue working, we must address the causes of HIV risk in the social and cultural contexts that create them."
The full APLA report is available online in PDF format. It can be seen at www.apla.org.