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No Rest for the Weary Where HIV Prevention Is Concerned


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Sept. 27, 2000 -- Society has come a long way in fighting HIV, the virus that causes AIDS. However, experts are warning that contentment could give rise to disaster and doctors and the federal government need to work harder to prevent HIV infections, according to a report released Wednesday by the Institute of Medicine.

"There has been remarkable progress in the way our nation has confronted the AIDS epidemic," says Harvey Fineberg, MD, PhD, who is with Harvard University in Boston and co-chair of the Institute's Committee on HIV Prevention Strategies in the U.S. "But the number of new infections remains unacceptably high. Every day, 100 Americans are newly infected with HIV. Much more work remains to be done." The committee's report is entitled No Time to Lose: Getting More From HIV Prevention.

Physicians need to do a better job of counseling patients who are already infected about how to avoid spreading the virus, says Fineberg. "Since every new infection begins with someone who is already infected, these people have great potential for preventing new infections." Experts agree the best way to do that is to abstain from sex and drug use. Short of that, the virus can also be kept at bay through condom use during sex and not sharing needles among drug users.

However, increased counseling of infected patients, as well as counseling and screening for those at high risk of infection, will not occur until two things happen, Fineberg adds. "The medical community has excellent guidelines and strategies for doing [a better] medical history on these patients. The problem is that they are not routinely incorporated into practice because insurance reimbursement doesn't pay for it. Also, it hasn't been stressed how important this element of preventive care is to individuals and to the community. It requires a system to put it in place and to pay for it."

Committee members also called for the federal government to present a unified front. "The message we heard over and over [from public health officials] is that they don't have a clear enough understanding of the way they can take the best advantage of the different programs coming at them from the federal government," says Fineberg. "It's very evident that there doesn't currently exist a single leadership responsible for all prevention efforts, either within the Department of Health and Human Services or in the federal government as a whole."

Other committee recommendations for improving HIV prevention efforts included:

  • Do a better job of allocating money to prevention programs that work. One example of a poor use of HIV prevention resources is a new blood test for potential blood donors, according to committee member James Trussell, associate dean of the Woodrow Wilson School of Public and International Affairs at Princeton University, in Princeton, N.J. The test will prevent transmission of HIV through donated blood -- a handful of cases -- yet it will cost the U.S. $60 million to administer.
    "Contrast that with needle exchange programs, which cost between $3,000 to $50,000 for every infection prevented," says Trussell. "That would save many more lives."
    In addition to needle-exchange programs, prevention of HIV transmission from pregnant women to their babies is another cost-effective strategy, according to the report. Pregnant women who test positive for HIV can be given drugs that prevent the virus from being passed on to their unborn babies in the vast majority of cases.
  • Perform more research aimed at analyzing the effectiveness of various prevention strategies. "Such efforts will require the participation and collaboration of the funding agencies, researchers, service providers, and communities," the committee noted in its report.
  • Increase the development and use of new biotechnologies aimed at preventing HIV infection, such as vaccines and female condoms. "Federal agencies should continue to invest in the development of products and technologies linked to HIV prevention," the committee writes.
  • Overcome social and policy barriers that impede HIV prevention efforts, including poverty, racism, and sexism. Fineberg noted that the federal government has allocated $250 million to abstinence-only sex education programs rather than programs that discuss birth control and sexuality, despite a lack of data showing those abstinence-only programs are effective. Trussell questions whether that was a wise strategy: "To parents I say, why would you want to put all your eggs in the abstinence-only basket when there's not one shred of evidence that it works?"

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