Desperate for a
way to stop the escalating spread of HIV among young gay
men, public health officials are looking to novel
strategies, such as enlisting local gay opinion
leaders to urge their peers to practice safe sex.
from such a project in North Carolina led the Centers for
Disease Control and Prevention to begin rolling it out on a
broader scale, to more than 200 community groups. The
budget is $1.5 million over a two-year period.
The idea is to
give gift coupons to popular, influential men in the gay
community and encourage them to talk up condom use, regular
HIV testing, and other responsible actions.
It may sound
frivolous, but little else has proven effective for the men
most affected by the epidemic.
Last week, new
figures showed still-rising HIV infections in gay and
bisexual men, with about 53% of new cases in that group.
Meanwhile, HIV rates among injection-drug users and
heterosexuals is declining.
The CDC says it's
also committed $5 million to a five-year social
marketing campaign to promote HIV testing to young black gay
and bisexual men, who have been diagnosed with HIV at
especially high rates.
"The CDC is
committed to ensuring that its resources are going to the
populations hardest hit by the epidemic," said Richard
Wolitski, acting director of the CDC's Division of
approaches are an encouraging sign of help, but the funding
behind them doesn't come close to raising prevention
spending to the level most experts say it should be,
said Julie Scofield, executive director of the
National Alliance of State and Territorial AIDS
"It's a drop in
the bucket," she said.
Scrutiny of U.S.
prevention efforts increased after the CDC's release
last weekend of new estimates of annual HIV infections. The
CDC said the nation had roughly 56,300 new infections
of the AIDS virus in 2006 -- a dramatic increase from
the annual estimate of 40,000 used for the last dozen
acknowledged it had been undercounting but said new testing
technology offered a more accurate picture of trends in the
U.S. epidemic. For example, the new report found
infections are falling among heterosexuals and
injection-drug users, even as they continue to rise in
men who have sex with men, especially among blacks.
complained that prevention spending in general has been
too low, and that what is spent is not targeted properly.
The CDC's HIV
prevention budget has remained at roughly $700 million
since 2001, while costs have risen. (That's about 3% of what
the federal government spends on AIDS; much of the
rest is on medicines, health care, and research.)
prevention programs that target gays and bisexuals are
scattershot. Even in progressive cities, these efforts
sometimes amount to little more than offers of testing
and free condoms, some experts said.
was focused on gay men when AIDS first hit the United
States in the 1980s. But the epidemic gradually became
perceived as a threat to the general population, and
some political leaders have kept the focus away from
gay men, said Leroy Blea, a Berkeley, Calif., health
official who is past president of the National Association
of County and City Health Officials.
"It's not a very
easy population to fund," Blea said. "It's often more
politically viable to fund programs for women and children
Division of HIV/AIDS Prevention estimates that about 42% of
its fiscal 2007 funding was targeted at gay and
bisexual men. That translates to about $280 million.
But with 53% of
new HIV infections occurring in men who have sex with
men, that's not enough, some experts said.
"At a minimum, we
need to be matching percentages to where the epidemic
is," said David Holtgrave of Johns Hopkins University.
programs are largely funded at the state and local level,
and funding has not quite kept up on those levels
about 70% of HIV infections occur in men who have sex with
men, but about 64% of the state health budget targeting HIV
is focused on gay and bisexual males.
Some experts say
it's been hard to find prevention efforts proven to
work, and that's especially true for black and Hispanic
prevention became clear about five years ago in North
Carolina, with an outbreak of HIV among male students at
some historically black colleges.
Carolina Department of Health and Human Services tried a
program that had been tested in white gay men in London.
With $1 million
in funding from the CDC, North Carolina health officials
went to gay nightclubs in Charlotte, Raleigh, and Greensboro
to recruit men who were well-liked and socially
leaders were given four $25 gift cards, along with
marketing materials, to talk up safe sex. A study of the
effort, published in June in the American Journal
of Public Health, indicated more men were
practicing safe sex.
The research was
based on repeated surveys over time of about 300 men. It
found a 32% reduction in unprotected anal intercourse during
2005, and a 40%
The funding ran
out and the program ended. And the surveys weren't backed
up by HIV testing.
But CDC officials
are impressed enough to package it and are identifying
other cities where it can be tried. The training of
community activists in the strategy should start in a
few months, Wolitski said. (AP)
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