The Centers for Disease Control and Prevention last week awarded funds for HIV/AIDS programs that will be used to implement high-impact HIV prevention (.pdf), also known as test and treat, a new “approach to reducing HIV in the United States.”
The CDC and its partners “are pursuing this High-Impact Prevention approach” that “promises to increase the impact of HIV prevention efforts,” to achieve the goals of the National HIV/AIDS Strategy.
The CDC awarded Florida almost $29 million for the 2012 funding cycle in two categories. The agency announcement indicates that in one category, more than $22 million will be directed to prevention activities under the high impact prevention approach, and “for the first time, health departments are required to direct at least 75 percent of CDC funds in this category to four key areas: HIV testing; comprehensive prevention services for HIV positive individuals and their partners; condom distribution; and efforts to align policies to optimize HIV prevention, care and treatment.”
“The funding for the ‘implementation cascade’ of the new strategy is faithful to CDC’s new rationales: Test and Treat and the related strategy Treatment as Prevention,” Stephen Fallon, president of Skills 4, writes to The Florida Independent. ”As anticipated since the August publication of the National HIV / AIDS Strategy, this new direction does crowd out the bulk of behavioral prevention,” i.e. prevention for people who are HIV-negative but at risk for an HIV infection.
The CDC also announced that in its other funding category, Florida received more than $6.6 million along with other states and cities “with large numbers of African-Americans and Latinos living with HIV” to “expand access to HIV testing services, primarily in healthcare settings, for these populations and others heavily affected by HIV.”
According to the CDC, populations heavily affected by HIV include gay and bisexual men (the group most severely and disproportionately affected by the epidemic) of all races and ethnicities, African-Americans, Hispanics/Latinos, injection drug users and transgender individuals.
Fallon, who has been involved in HIV prevention for 25 years, writes that Florida’s $6.6 million is “almost all reserved for linking patients to testing in medical settings” and “represents a change to the way that funding has been used.” He adds that “CDC funds have provided for testing in Community Based Organizations, precisely because some who may be HIV positive are reluctant to enter clinical facilities.”
“There are huge behavioral reasons why it is not easy to drag people to the clinic and force them on to treatment before they’re ready,” Fallon writes the Independent, adding that people who have tried treatments that failed when they developed resistance, or people who got off treatment when they couldn’t stand the side effects show that compliance is difficult.
“It’s actually easier to get somebody to at least put a condom on, on those nights that they happen to be having sex with an untested partner, as opposed to trying to get somebody on to treatment and stay on it every single day for the rest of their life whether they are having sex or not,” Fallon writes.
Fallon also says that test and treat “relies primarily upon the negative partner staying exclusive to their well treated HIV positive partner. Then how does that apply if both partners may be having sex with others?”
According to Fallon, test and treat “has not been tested with significant numbers of gay men, especially gay men in the United States,” and though it has been used in other countries, “the thinking is if it’s overseas where it is more dire, if anything succeeds that must mean it is the ultimate test because it was done overseas.”
Fallon adds that in the United States you “have so many choices, so many options and the visible realities of AIDS aren’t so noticeable. So you can’t guarantee even if something is a great idea that everyone is going to come running towards it.”
The Orlando Sentinel reported last week that CDC 2012 funds add up to nearly $339 million and that “Florida, which has the third-highest rate of HIV in the country, will receive nearly 9 percent of the total national funding this year. The state also has the second-highest rate of pediatric AIDS cases in the country.”