Are the federal Centers for Disease Control ramping up or down on HIV prevention? The CDC fell way short of its 2001 target of reducing new HIV cases by 50 percent over five years—rates are up in some communities and barely down in others. But in March, the agency kicked up some excitement by announcing a “heightened response” to the HIV emergency among African Americans, a major prevention push that would boost testing and outreach from coast to coast in the hard-hit black community. Then earlier this month, the overall 50 percent target was quietly shaved to 10 percent. Confusion reigned—and AIDS advocates sounded an alarm.
A slew of prevention workers interviewed by POZ say the drop to a 10 percent goal will undermine fund-raising for their programs and shred progress made so far on stemming the epidemic. “It feels as though the CDC has given up” on HIV prevention, says Ruth True, who coordinates HIV testing and counseling at AIDS Services of Austin. Mark McLaurin of the New York State Black Gay Network says, “We’ve lost a weapon—even if it’s just rhetorical—to fight for more programs and more funding.” Adds David Munar at the AIDS Foundation of Chicago, “How do we ask Congress to increase funding for prevention if the CDC puts forward this message that reducing infections is not achievable?”
No doubt, budgetary restrictions are at least in part behind this latest move. While the size of the epidemic keeps growing, the budgets handed to the CDC year after year since 2001 have stayed flat. But Sean Barry at the Community HIV/AIDS Mobilization Project (CHAMP) believes the 10 percent drop was all about appearances. He says the agency “just moved the goalposts closer” so it wouldn’t look like their efforts were failing.
The CDC itself says the new 10 percent goal represents an advance because it’s “more realistic.” “We’re still committed to the more ambitious [50 percent] vision [set in 2001], but we updated the plan to [reflect] current resources,” says Kevin Fenton, MD, who directs the CDC’s National Center for HIV, STD and TB Prevention. Fenton also challenges the characterization of the years since 2001 as a period of policy failure. “We see tremendous progress,” he says, citing “declines in risk behavior among youth, mother-to-child transmission—and the fact that most HIV-positive people are protecting their partners.”
Jesse Milan Jr., a Washington, DC, businessman who is cochair of a CDC community advisory committee, agrees with Fenton. “That 50 percent goal was wildly unrealistic, given the change of administration in 2001 and later events”—costly wars, for instance. As for the lower target, Milan points out, the new 10 percent figure is to be achieved in three years, while 50 percent was a five-year plan. What's more, “This one is achievable. And this time, we have benchmarks,” to measure progress and hold officials accountable for any failures.
So far, the CDC has been unable to convince the administration to move more resources into the area of HIV prevention. Who’s to blame for that? Walt Senterfitt, a Los Angeles health department epidemiologist and CHAMP board member who used to work for the CDC, says, “That the CDC is accepting the current administration’s barriers to needle exchange and comprehensive sex education…confirms [the CDC’s] lack of seriousness about doing what is necessary to stop the epidemic.”
Fenton says the CDC’s hands are tied by the budget (and by administration requirements on abstinence-only education). He also dismisses fears that the CDC’s new target will encourage funding cuts to prevention programs. The plan, he says, is to keep prevention programs afloat—and support testing especially—by funneling money away from research. “The money for testing is coming from what we already have from research projects that are at an end,” according to Fenton, “instead of investing in more research.”
Switching around budgets internally is tricky, though, because advocates say that HIV-prevention research is among the most important and most overlooked areas of the CDC’s work at this point. Traditional prevention methods aren’t always effective—for black men who have sex with men (MSMs), for example. And there’s been little support for exploring new avenues.
“For black gay men, the funerals never stopped,” says McLaurin. “And we’ve been pressing for more research, not less, because the usual prevention strategies for gay men don’t work for black MSMs.” For instance, “Huge numbers of black gay men [are] affected by childhood sexual trauma, way out of proportion to other men.” And he says that crack is much more of a problem in this community than crystal meth.
Pretty much everyone in this debate can agree on one thing: What’s missing are resources and fresh ideas on fighting HIV—and effective direction from above. “The United States demands that other countries present multilayered plans for dealing with HIV,” says Milan, “but we still do not have one. It’s almost unfair to look at the one agency that has a national plan for prevention,” while the rest of the government—from labor to justice to commerce—has nothing, he says.
The 2008 presidential race and the Democratic Party’s growing influence makes the focus on Washington still more key. “The stars are aligned to get better HIV programs and funding,” says CHAMP’s Barry. The changing political mood of the Congress and the American public calls, indeed, for a “heightened response.”