Index
A
Abstinence education programs, components of, 119n
“Abstinence-plus” programs, 117
Access
to drug abuse treatment, 106-116
to sterile drug injection equipment, 114-116
ACHSP. See Advisory Committee for HIV and STD Prevention
Acquired immunodeficiency syndrome. See AIDS
ACSUS. See AIDS Cost and Services Utilization Survey
ADAMHA Reorganization Act of 1992, 167
ADAP. See AIDS Drug Assistance Program
Adolescent AIDS cases, by exposure category, 141
Adolescent Family Life Act (AFLA), 118-119
Adolescent sex workers, 189
Adult AIDS cases, by exposure category, 141
Adult correctional systems, HIV/AIDS education, harm reduction, and discharge planning programs in U.S., 122
Advisory Committee for HIV and STD Prevention (ACHSP), 74
AFLA. See Adolescent Family Life Act
Africa, HIV incidence in, 105, 140
African Americans
Medicaid services provided to, 57
rates of AIDS infection among, 143-145
Agency for Health Care Quality and Research, spending on HIV/AIDS, 172
Aggregate HIV incidence, estimating, 173
AIDS cases
adult/adolescent, by exposure category, 141
and co-occurring conditions, 147-148, 152
geographic distribution of, 145-146
inadequacy of reporting based on, 15
increases in, 1
lag in diagnosis time for, 4, 81n
perinatally acquired, 144-145
providers caring for, 55-56
“public health” responses to, 22
in racial and ethnic minorities, 144-145
rates per 100,000 population, 146
and sexual orientation, 2
in women, 142-143
in youth, 143-144
AIDS Cost and Services Utilization Survey (ACSUS), 56
AIDS Drug Assistance Program (ADAP), 169
AIDS Education Training Centers, established under the Ryan White CARE Act of 1990, 170
AIDS incidence
versus allocation of HIV prevention funds, 32
CDC-allocation of HIV prevention funds versus, 32
estimates of, 141
by state, 32
AIDS pandemic
global, 140
projecting, 15
AIDS Research Program Evaluation Working Group, 76-77
AIDS service organizations (ASOs), 68
improving organizational capacity of, 72-73
Alaskan Natives, HIV prevention programs for, 171
Alcohol use, 107n
Alliance for Microbicide Development, 85-86, 90
Alliances, for health departments, 193
Allocating resources for HIV prevention, 5-6, 26-49.
See also HIV prevention investments
versus AIDS incidence by state, 32
assessing the cost-effectiveness of, 32-35
calculations for, 175-177
at the community level, 39
current allocation of federal, 28-32
at the national level, 39-46
optimizing, 44-46
a strategic vision for, 37
using epidemic impact as a measure of success, 35-37
Alternative barrier methods, 83-86
the female condom, 83-84
microbicides, 84-86
“America Responds to AIDS” (ARTA), 158
American Academy of Pediatrics, 118
American Foundation for AIDS Research, 90
American Indians, HIV prevention programs for, 171
American Journal of Public Health, 173
Anal intercourse, male condom use during, 36
Annual infections prevented
cost-effectiveness versus proportional allocation, 43
impact of investing in better, more expensive programs, 45
percentage improvement, 44
Antimicrobial therapies, advances in, 7
Antiretroviral therapies, 86-87
HIV-infected persons receiving, 51
optimizing patient adherence to, 53-54
Public Health Service Task Force recommendations for use of, 34
ARTA. See “America Responds to AIDS”
ASOs. See AIDS service organizations
Assessing the cost-effectiveness of HIV prevention interventions, in allocating resources, 32-35
At-risk populations, 2, 12, 99-100
B
“Back calculations,” 148
Balanced Budget Act of 1997, 119
Barrier methods, alternative, 83-86
Barrier products, 171
Barriers to HIV care, 98-128
access to drug abuse treatment, 106-116
access to sterile drug injection equipment, 114-116
comprehensive sex education and condom availability in schools, 116-120
HIV prevention in correctional settings, 120-128
lack of leadership, 104-105
misperceptions, 103-104
poverty, racism, and gender inequality, 98-100
requests for public comment on, 189-190
the sexual “code of silence,” 100-101
stigma of HIV/AIDS, 101-103
Base scenario, at the national level of resource allocation, 42
Baseline rate of new infections, 33
Behavioral interventions to prevent HIV infection, 155-156
new infections, 153-155
Behavioral surveillance, 17
Bill and Melinda Gates Foundation, 90
Biomedical interventions, to prevent HIV infection, 156-157
Biomedical strategies, used in preventing new HIV infections, 153-155
Bleach, used for HIV disinfection, 125
Blood samples, procedures for taking, 20
Blood supply
in assessing the cost-effectiveness of HIV prevention interventions, 33-34
protecting, 33-34
Buprenorphine, 110
C
Capitation payments, 60
CAPS. See Center for AIDS Prevention Studies model
CARE Act. See Ryan White Comprehensive AIDS Resources Emergency Act of 1990
Case finding approach, 16-19
alternative to surveillance, 16
Case reporting, in tracking the HIV epidemic, 16-19
CBOs. See Community-based organizations
CDC. See Centers for Disease Control and Prevention
CDC Behavioral and Social Science Volunteer Project, 69, 72
Center for AIDS Prevention Studies, 193
Center for AIDS Prevention Studies (CAPS) model, 75-76
Center for Mental Health Services (CMHS), 167
Center for Substance Abuse Prevention (CSAP), 167
Center for Substance Abuse Treatment (CSAT), 167
Centers for AIDS Research (CFARs), 76
Centers for Disease Control and Prevention (CDC), 2, 11, 34
allocation of HIV prevention funds versus AIDS incidence by state, 32
intervention/program implementation, 164-165
leading role played in HIV prevention, 26, 47
policy, 165
position on HIV testing, 55
program evaluation, 165
publicly funded sites of, 55n
recommendations to, 59
spending on HIV/AIDS, 164-165
studies by, 52-53
syphilis elimination plan, 62
technical assistance, 165, 186
Changes in Medicaid and Ryan White Care Act programs needed to encourage HIV prevention, 58-63
Changes in the epidemic, 139-151
AIDS trends in the United States, 139-148
demographics of, 142-146
HIV incidence and prevalence, 148-149
Changes needed to encourage HIV prevention, 58-63
encouraging HIV prevention in CARE Act programs, 61-63
financing options for Medicaid coverage, 58-61
Characteristics of Reputationally Strong Programs Project, 69
Children
health care settings utilized by, 56
programs for under the Ryan White CARE Act of 1990, 170
Clinical care for HIV-infected persons financing, 56-58
programs that provide, 55-58
Clinical settings, 50-67
changes in Medicaid and Ryan White Care Act programs needed to encourage HIV prevention, 58-63
DHHS-wide policies to encourage integration of prevention into clinical care, 63
programs that provide clinical care to HIV-infected persons, 55-58
Clinton Administration, 29
CMHS. See Center for Mental Health Services
Co-occurring conditions, 152
trends in the United States, 98, 147-148
Cocaine use, 107n
“Code of silence,” as a social barrier, 100-101
Commission on Health Research for Development, 90
Community and Migrant Health Center (CHCs) program, 57-58
Community-based organizations (CBOs), 68, 193
improving organizational capacity of, 72-73
Community Health Centers (CHCs)
HIV tests performed at, 55n
programs of, 57
Community-level resource allocation for HIV prevention, 39
Community Planning Groups (CPGs), 28, 29, 165, 191
Community Planning Leadership Summit, 180-185
Compendium of HIV Prevention Interventions with Evidence of Effectiveness, 69, 70, 152
Comprehensive sex education, in schools, 116-120
Condom availability, 157
in correctional facilities, 125-126
in schools, 116-120
Condom use
female, 83-84
male, 36
Confidentiality issues, 18-19.
See also Reporting issues
in testing, 29
Connecticut, drug paraphernalia laws in, 115
Consensus Panel on Interventions to Prevent HIV Risk Behaviors, 119
Consortium for Industrial Collaboration in Contraceptive Research, 90
Coordination of programs
requests for public comment on, 188-189
Correctional systems
condom availability in, 125-126
HIV/AIDS education, harm reduction, and discharge planning programs in U.S. adult, 122
HIV prevention in, 120-128
needle exchange programs in, 126
Cost-effectiveness of HIV prevention interventions, 32-35, 107n
assessing in the allocation of resources, 32-35
implementing needle exchange programs, 34-35
preventing perinatal transmission of HIV, 34
versus proportional allocation in preventing annual infections, 43
protecting the blood supply, 33-34
Costs of HIV interventions, 40-42, 174-175
Costs of HIV testing, 83
Costs of HIV treatment, 42
Counseling, 106
by race and ethnicity, 30
CPGs. See Community Planning Groups
CSAP. See Center for Substance Abuse Prevention
CSAT. See Center for Substance Abuse Treatment
Current allocation of federal HIV prevention funds, in allocating resources, 28-32
Current national AIDS surveillance system, 15
D
Data gathering activities, 180-193
Community Planning Leadership Summit, 180-185
problems with expanding, 186
requests for public comment, 185-190
site visits to state health departments, 190-193
Data needs, requests for public comment on, 185-186
Deaths, estimates of, 141
Demographics of the AIDS epidemic, 14, 142-146
cases in racial and ethnic minorities, 144-145
cases in women, 142-143
cases in youth, 143-144
geographic distribution, 145-146
Dental Reimbursement Program, established under the Ryan White CARE Act of 1990, 170
Department of Defense Health Care Systems, 56
Department of Health and Human Services (DHHS)
Agency for Health Care Quality and Research, 172
categorization of those needing treatment, 108
Centers for Disease Control and Prevention, 28, 164-165, 186
Food and Drug Administration, 170-171
Health Care Financing Administration, 171
Health Resources and Services Administration, 168-170, 182, 186
Indian Health Service, 171
National Institutes of Health, 28, 165-167, 182
need for strong leadership from, 4
policies to encourage integration of prevention into clinical care, 63
regulatory role of, 111
spending on HIV/AIDS, 28, 164-172, 182
Substance Abuse and Mental Health Administration, 28, 167-168
Department of Justice, 56
Department of Veterans Affairs Health Care System (VA), 56
Description and mathematical statement of the HIV prevention resource allocation model, 173-179
allocating resources for HIV prevention, 175-177
the costs of HIV prevention programs, 174-175
estimating aggregate HIV incidence, 173
estimating the efficacy and reach of HIV prevention programs, 174
Detecting HIV antibodies, rapid testing methods for, 80-83
DHHS. See Department of Health and Human Services
Diabetes, 190
Diagnosis time for AIDS cases, lag in, 4, 81n
Discharge planning in correctional settings, 121-123
for U.S. adults, 122
Disease progression, advances in antiretroviral therapies to prevent, 2, 7, 14
Disinfection, use of bleach for, 125
Domestic federal HIV/AIDS spending, fiscal year 1995-1999, 163
Drug abuse, link to spread of AIDS, 106
Drug abuse treatment
access to, 106-116
in correctional settings, 124-125
Drug control spending, federal, 111
Drug Enforcement Agency, regulatory role of, 111
Drug injection equipment, access to sterile, 114-116
Drug paraphernalia laws, in Connecticut, 115
Drug-resistant HIV, re-infection with, 52
E
Early and Periodic Screening, Diagnostic, and Treatment program, 58
Early intervention grants, under the Ryan White CARE Act of 1990, 170
Education
components of abstinence programs, 119n
in U.S. adult correctional systems, 122
Efficacy of HIV interventions, 40, 174-175
measured in quality adjusted life years, 38n
EIA test. See Enzyme-linked immunoassay test
Eligible Metropolitan Areas (EMAs), 169
Enzyme-linked immunoassay (EIA) test, 33, 81
Epidemic impact, allocation of resources as a measure of success, 35-37
Estimates
of aggregate HIV incidence, 173
of AIDS incidence, deaths, and prevalence in adults, 141
of efficacy and reach of HIV prevention programs, 174
Ethnic minorities, AIDS cases in, 144-145
Ethnicity
counseling, testing, referral, and partner notification by, 30
health education and risk reduction by, 30-31
proportion of AIDS cases by, 145
Evaluations
of Centers for Disease Control and Prevention programs, 165
of HIV prevention programs for workability, 192
Expenditures for HIV prevention. See Allocating resources for HIV prevention
Expensive programs, impact on preventing annual infections of investing in, 45
Exposure categories, 140-141
adult/adolescent AIDS cases by, 141
F
FDA. See Food and Drug Administration
Federal Bureau of Justice, studies by, 124
Federal drug control spending, 111
Federal HIV prevention funds, current allocation of, 28-32
Federal Regulation of Methadone, 111n
Federal spending on HIV/AIDS, 162-172
additional technical assistance needed in HIV prevention activities, 192
Agency for Health Care Quality and Research, 172
Centers for Disease Control and Prevention, 164-165
Department of Health and Human Services, 164-172
for fiscal year 1995-1999, domestic, 163
Food and Drug Administration, 170-171
Health Care Financing Administration, 171
Health Resources and Services Administration, 168-170
Indian Health Service, 171
National Institutes of Health, 165-167
overview of, 162-164
Substance Abuse and Mental Health Administration, 167-168
Fee-for-service, Medicaid coverage for, 59-60
Female condom use, 83-84
Financing options for Medicaid coverage, 58-61
Medicaid fee-for-service, 59-60
Medicaid managed care organizations, 60-61
Food and Drug Administration (FDA)
recommendations concerning tests, 34, 81-82
regulatory role of, 110-111, 170
spending on HIV/AIDS, 170-171
Funding HIV prevention. See Allocating resources for HIV prevention
G
GAO. See U.S. General Accounting Office
Gates Foundation, 90
Gender inequality, as a social barrier, 98-100
Geographic distribution, of AIDS cases, 145-146
Global HIV/AIDS pandemic, 140
Grants.
under the Ryan White CARE Act of 1990, 169-170
under the Substance Abuse and Mental Health Administration, 167-168
H
Hampden County Correctional Center (in Massachusetts), HIV prevention in, 123
Harm reduction programs, in correctional settings, 122, 125-128
HCFA. See Health Care Financing Administration
HCSUS. See HIV Cost and Services Utilization Study
Health Care Financing Administration (HCFA), 57, 171
Medicaid services under, 59, 171
Medicare services under, 171
recommendations to, 59
Health departments, potential new partnerships or alliances for, 193
Health education, by race and ethnicity, 31
Health professionals’ training, integrating HIV prevention early in, 54
Health Resources and Services Administration (HRSA), 28, 77, 168-170, 182
Ryan White Comprehensive AIDS Resources Emergency Act of 1990, 168-170
spending on HIV/AIDS, 168-170, 186
studies by, 52-53
Heart disease, 190
Hewlett Foundation, 90
The Hidden Epidemic, recommendations from, 101
Hierarchical surveillance, 141n
Hispanics
Medicaid services provided to, 57
rates of AIDS infection among, 143-145
HIV/AIDS High Risk Behavior Prevention/ Intervention Model for Youth Adult/Adolescent and Women Program, 168
HIV antibodies, rapid testing methods for detecting, 80-83
HIV case reporting, in tracking the epidemic, 16-19
HIV Cost and Services Utilization Study (HCSUS), 56
HIV Cost Study, 168
HIV disinfection, use of bleach for, 125
HIV education, harm reduction, and discharge planning programs, in U.S. adult correctional systems, 122
HIV incidence estimation
changes in, 148-149
population-based, in tracking the epidemic, 19-23
HIV-infected persons
categorization of by DHHS, 108
complacency among, 1
extending prevention efforts to, 50
programs that provide clinical care to, 55-58
receiving antiretroviral therapy, 51
HIV infections, allocating resources for prevention of new, 5-6, 11
HIV interventions, cost, reach, and efficacy of, 40
HIV outreach grants, under the Substance Abuse and Mental Health Administration, 168
HIV pandemic, global, 140
HIV prevalence, changes in, 148-149
HIV prevention
changes needed to encourage, 58-63
defining, 27n
encouraging in CARE Act programs, 61-63
estimating the efficacy and reach of, 174
integrating early in health professionals’ training, 54
leading role played by the Centers for Disease Control and Prevention in, 26
programs for Native Americans, 171
resource allocation for, 38-46
rethinking, 11-13
unrealized opportunities for improving, 193
HIV Prevention Community Planning Process, 76
HIV Prevention Evaluation initiative, 75n
HIV prevention funds, CDC allocation of, versus AIDS incidence by state, 32
HIV prevention in correctional settings, 120-128
drug abuse treatment, 124-125
harm reduction programs, 125-128
HIV prevention education, 123
HIV Prevention Initiative for Youth and Women of Color, 168
HIV prevention investments, 33
development of new tools and technologies for, 7-8
strategic vision in allocating resources, 26, 37
HIV prevention research dissemination, examples of, 70-71
HIV Prevention Science Initiative, 166
HIV prevention strategies
description and mathematical statement of resource allocation model for, 173-179
examples of research dissemination, 70-71
prioritizing and selecting for implementation, 191
HIV risk assessments, guides for conducting, 54
HIV status
emphasis on people learning, 81
outreach to those of unknown, 61
HIV surveillance approaches, comparison of, 22
Homicide, 190
HRSA. See Health Resources and Services Administration
Human immunodeficiency virus. See HIV
I
IDUs. See Injection drug users
Immunofluorescence assay, 81n
Impact of investing in better, more expensive programs, on preventing annual infections, 45
Implementation
of Centers for Disease Control and Prevention programs, 164-165
of HIV prevention programs, 192-193
of needle exchange programs, 34-35
removing obstacles to, 13
requests for public comment on, 188-189
Improving HIV prevention, unrealized opportunities for, 193
Incidence estimation, 141
declines in, 14
population-based, in tracking the HIV epidemic, 19-23
Indian Health Service, spending on HIV/ AIDS, 171
Infants, programs for under the Ryan White CARE Act of 1990, 170
Infected persons
complacency among, 1
extending prevention efforts to, 50-51
programs that provide clinical care to, 55-58
Infections. See HIV infections;
New HIV infections;
Re-infection
Injection drug users (IDUs), 34.
See also Sterile drug injection equipment
programs targeting, 46n, 102, 189
providers caring for, 51
Institute of Medicine (IOM), 2, 111-112
defining drug addiction, 112-113n
International AIDS Vaccine Initiative, 90
“Interventions in a box,” 73
Interventions to prevent HIV infection, 152-161.
See also Early intervention grants
behavioral interventions, 155-156
biomedical and technological interventions, 156-157
in Centers for Disease Control and Prevention programs, 164-165
interventions associated with the treatment of co-occurring conditions, 156
societal interventions, 157-158
used in preventing new HIV infections, 153-155
Investment-based approach. See HIV prevention investments
K
Knowledge Development and Application (KDA) programs, under the Substance Abuse and Mental Health Administration, 168
L
LAAM. See Levo-alpha-acetylmethadol (LAAM)
Leadership, 185
lack of as a social barrier, 3-4, 104-105
Levo-alpha-acetylmethadol (LAAM), 110n
Lifesaving Vaccine Technology Act of 1999, 91
Local resource allocation, support for, 46-47
M
Mail Order Drug Paraphernalia Act, 115
Male condom use, 36
Managed care organizations (MCOs), Medicaid coverage for, 59-61
Maryland, coded system of HIV case reporting, 19
Massachusetts, coded system of HIV case reporting, 19
Massachusetts correctional system, HIV prevention in, 123
Mathematical statement, of the HIV prevention resource allocation model, 41, 173-179
Measurement techniques, changes in, 20
Medicaid services
Early and Periodic Screening, Diagnostic, and Treatment program, 58
fee-for-service, 59-60
financing options for coverage, 58-61
managed care organizations, 59-61
provided to African Americans and Hispanics, 57
provided under the Health Care Financing Administration, 171
Medical Research Council, 89
Medicare services, provided under the Health Care Financing Administration, 171
Men who have sex with men (MSM), 140, 183
Mental illness, link to spread of AIDS, 147, 152
Methadone, regulation of, 110-111
Metropolitan areas, grants to under the Ryan White CARE Act of 1990, 169
Microbicides, 84-86
advances in, 7
workings of, 84-85
Military health care options. See Department of Defense Health Care Systems
Misperceptions, as a social barrier, 103-104
Modeling, statistical, 19
Modes of transmission. See Transmission
Monitoring HIV prevention programs, additional information needed for, 192
Moriah Fund, 90
MSM. See Men who have sex with men
N
N-9. See Nonoxynol-9
Naltrexone, 110
NAT test. See Nucleic Acid Amplification Technology test
National AIDS Control Programme (in Uganda), 105
National AIDS surveillance system, in tracking the epidemic, 15
National Cancer Institute, 165, 167
National Center for Research Resources, 165
National Health Interview Survey, 20
National Heart, Lung and Blood Institute, 165
National Institute for Drug Abuse, 165
National Institute of Allergy and Infectious Diseases, 165, 167
National Institute of Child Health and Human Development, 165
National Institute of Justice, studies by, 125
National Institute of Mental Health (NIMH), 75, 165
National Institutes of Health (NIH), 28, 165-167, 182
Consensus Panel on Interventions to Prevent HIV Risk Behaviors, 119, 152
nonvaccine prevention research under, 166-167
spending on HIV/AIDS, 165-167
vaccine research under, 68, 167
National level resource allocation for HIV prevention, 39-46
base scenario, 42
optimistic scenario, 42
pessimistic scenario, 42
National Research Council (NRC), 20, 34
Native Americans, HIV prevention programs for, 171
Needle exchange programs
in assessing the cost-effectiveness of HIV prevention interventions, 34-35
in correctional facilities, 126
implementing, 34-35
programs targeting, 46
New HIV infections
baseline rate of, 33
developing an accurate surveillance system for, 4-5
populations growing in, 2
NIH. See National Institutes of Health
NIMH. See National Institute of Mental Health
Nonoxynol-9 (N-9), 85
Nonvaccine prevention research, under the National Institutes of Health, 166-167
Nucleic Acid Amplification Technology (NAT) test, 34
O
OAR. See Office of AIDS Research
Office of AIDS Research Advisory Council, AIDS Research Program Evaluation Working Group, 76-77
Office of AIDS Research (OAR), 165
Office of National Drug Control Policy, 107
Opportunistic infections, tuberculosis, 52
Opportunities
requests for public comment on, 189-190
unrealized, for overcoming social barriers, 106-128
Optimistic scenario, at the national level of resource allocation, 42
Outreach to those of unknown HIV status, CARE Act Title III support for, 61
Overcoming social barriers, 97-135
social barriers described, 98-105
unrealized opportunities for, 106-128
P
PACHA. See Presidential Advisory Council on HIV/AIDS
Partner notification, by race and ethnicity, 30
“Partnership for Health” studies, 53
Partnerships for health departments, 75, 193
Patients. See HIV-infected persons
“Payer of last resort,” CARE Act programs as, 57, 169
Pediatric HIV surveillance, 18
Percentage improvement, in preventing annual infections, 44
Perinatal transmission
in acquired AIDS cases, 141-142
assessing the cost-effectiveness of HIV prevention interventions, 34
preventing, 7
Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), 119
Pessimistic scenario, at the national level of resource allocation, 42
“Physician Delivered Intervention for HIV+ Individuals,” 53
Planning effective HIV prevention programs
additional information needed for, 192
barriers encountered, 193
Policy issues
in Centers for Disease Control and Prevention programs, 165
explicit goals of, 11-12
Population-based HIV incidence estimation, in tracking the epidemic, 19-23
Poverty, as a social barrier, 98-100
Presidential Advisory Council on HIV/ AIDS (PACHA), 69, 74
Prevalence
in adults, estimates of, 141
changes in HIV, 148-149
effectiveness of, 11
“missing link” in, 187
of new HIV infections, 5-6, 153-155
of perinatal transmission of HIV, 34
Prevention budgets, 38-39
Prevention education, in correctional settings, 123
Prevention Marketing Initiative, 158
Prevention portfolio, 152-161
behavioral interventions, 155-156
biomedical and technological interventions, 156-157
interventions associated with the treatment of co-occurring conditions, 156
societal interventions, 157-158
Prevention research, requests for public comment on translating into practice, 187
Prevention Research Synthesis (PRS) project, 69
Prevention Science Working Group, 166
Prevention technology transfer
current efforts in, 68-72
opportunities for improving, 74-77
Prioritizing, HIV prevention strategies for implementation, 191
Privacy issues, 18-19
Program evaluation, requests for public comment on, 187-188
Proportion of AIDS cases, by race and ethnicity, 145
Proportionality
in allocation, versus cost-effectiveness, 5, 31-32
in preventing annual infections, 43
Protecting the blood supply, 33-34
Providers
caring for AIDS cases, 56
caring for injection drug users (IDUs), 51
PRWORA. See Personal Responsibility and Work Opportunity Reconciliation Act
Psychotherapy, 106
Public comment, requests for, 185-190
“Public health” responses to AIDS, 22
Public Health Service Act, Title XX, 119
Public Health Service Task Force, recommendations for use of antiretroviral drugs, 34
Publicly funded sites, of the Centers for Disease Control and Prevention, 55n
Q
Quality adjusted life years (QALYs), measure of effectiveness, 38n
R
Race
counseling, testing, referral, and partner notification by, 30
health education and risk reduction by, 30-31
proportion of AIDS cases by, 145
Racial minorities, AIDS cases in, 144-145
Racism, as a social barrier, 98-100
Rapid testing methods, for detecting HIV antibodies, 80-83
Rates of AIDS cases, per 100,000 population, 146
Rationale for a national system of HIV surveillance, in tracking the epidemic, 16
Re-infection, with drug-resistant HIV, 52
Reach of HIV intervention programs, 40, 174-175
Receptive anal intercourse, male condom use during, 36
Recommendations
for allocating prevention resources, 5-6, 37
for a CDC-created, population-based surveillance system, 4-5
to the Centers for Disease Control and Prevention, 59
for collaboration among federal agencies, 114
for congressional policy making, 120
for creating a surveillance system, 17-18, 22
general, 191-193
to the Health Care Financing Administration, 59
from The Hidden Epidemic, 101
for HIV prevention in correctional facilities, 126-127
for investing in local-level research and interventions, 6-7, 77
for investing in products and technologies linked to HIV prevention, 7-8, 91
for legalizing injection equipment, 116
for overcoming social barriers to HIV prevention, 8
for providing prevention services as standard for all HIV-infected persons, 6, 63
of Public Health Service Task Force for use of antiretroviral drugs, 34
Referrals, by race and ethnicity, 30
1990 Report of the Commission on Health Research for Development, 90
Reporting issues, 148
Requests for public comment, 185-190
on coordination and implementation of programs, 188-189
on data needs, 185-186
on opportunities and barriers, 189-190
on program evaluation, 187-188
on technical assistance, 186
on translation of prevention research into practice, 187
Research
barriers to effective technology transfer at the community level, 72-74
in Centers for Disease Control and Prevention programs, 165
current efforts in prevention technology transfer, 68-72
under the National Institutes of Health, 166-167
opportunities for improving prevention technology transfer, 74-77
translating into action, 6-7, 68-79
Research dissemination, examples of HIV prevention, 70-71
Resource allocation for HIV prevention, 38-46.
See also Allocating resources for HIV prevention
Risk assessments, guides for conducting, 54
Risk reduction, by race and ethnicity, 31
Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990, 29, 57, 168-170
AIDS Education Training Centers, 170
Dental Reimbursement Program, 170
early intervention grants, 170
encouraging HIV prevention in programs of, 61-63
grants to eligible metropolitan areas, 169
grants to states and territories, 169
as “payer of last resort,” 57, 169
Special Projects of National Significance, 123, 170
Title III support for outreach to those of unknown HIV status, 61
women, infants, children, and youth, 170
S
SAMHSA. See Substance Abuse and Mental Health Administration
SAPT. See Substance Abuse Prevention and Treatment block grants
Scenarios, at the national level of resource allocation, 42
Schools, comprehensive sex education and condom availability in, 116-120
Secondary infections, 52
Senegal, HIV incidence in, 105
Sentinel surveillance, 19-22
Serosurveys, 20
Sexual “code of silence,” as a social barrier, 100-101
Sexually transmitted diseases (STDs). See AIDS;
HIV
Shalala, DHHS Secretary Donna E., 115
Single Use Diagnostic System (SUDS) test, 81-82
Site visits to state health departments, 190-193
additional information needed for planning, implementing, or monitoring HIV prevention programs, 192
additional technical assistance needed from the federal government to support HIV prevention activities, 192
barriers encountered to planning or implementing effective HIV prevention programs, 193
evaluating HIV prevention programs for workability, 192
potential new partnerships or alliances health departments should pursue, 193
prioritizing and selecting HIV prevention strategies for implementation, 191
unrealized opportunities for improving HIV prevention, 193
Social barriers, 3, 12, 98-128
access to drug abuse treatment, 106-116
access to sterile drug injection equipment, 114-116
comprehensive sex education and condom availability in schools, 116-120
HIV prevention in correctional settings, 120-128
lack of leadership, 104-105
misperceptions, 103-104
poverty, racism, and gender inequality, 98-100
the sexual “code of silence,” 100-101
stigma of HIV/AIDS, 101-103
Social Security Disability Insurance (SSDI), 109
Societal interventions, to prevent HIV infection, 157-158
Special Projects of National Significance, established under the Ryan White CARE Act of 1990, 123, 170
Spermicides, 85
SSDI. See Social Security Disability Insurance
SSI. See Supplemental Security Income
Standard Metropolitan Statistical Areas, 41, 173
State health departments, 58-59, 190-193
additional information needed by for planning, implementing, or monitoring HIV prevention programs, 192
additional technical assistance needed by from the federal government to support HIV prevention activities, 192
barriers encountered by to planning or implementing effective HIV prevention programs, 193
evaluations of HIV prevention programs for workability by, 192
potential new partnerships or alliances for, 193
prioritizing and selecting HIV prevention strategies for implementation by, 191
unrealized opportunities for improving HIV prevention by, 193
State resource allocation, support for, 46-47
States and territories, grants to under the Ryan White CARE Act of 1990, 169
“The States of the HIV/AIDS Epidemic,” 139n
Statewide Community HIV Evaluation Project, 75n
Statistical modeling, 19
STDs. See AIDS;
HIV
Sterile drug injection equipment
access to, 114-116
policy recommendations concerning, 13
Stigma of HIV/AIDS, as a social barrier, 3, 97, 101-103
Strategic vision for HIV prevention investments
in allocating resources, 37
elements of, 4
Stroke, 190
Substance Abuse and Mental Health Administration (SAMHSA), 28, 77, 108n, 167-168
Knowledge Development and Application programs under, 168
SAPT block grant-funded early intervention services (HIV set-asides) under, 167-168
SAPT block grants under, 167
spending on HIV/AIDS, 167-168
studies by, 110
Targeted Capacity Expansion and HIV outreach grants under, 168
Substance Abuse Prevention and Treatment (SAPT) block grants, 28, 58
funding of early intervention services (HIV set-asides), 167-168
under the Substance Abuse and Mental Health Administration, 167
SUDS. See Single Use Diagnostic System test
Supplemental Security Income (SSI), 109
Support for HIV prevention. See Allocating resources for HIV prevention;
HIV prevention investments
Surveillance approaches
alternative to case finding, 16
behavioral, 17
in Centers for Disease Control and Prevention programs, 165
comparison of HIV, 22
developing an accurate, for new HIV infections, 4-5
hierarchical, 141n
sentinel, 19
in tracking the national AIDS epidemic, 14-15
Survey of Childbearing Women, 20, 29
Syphilis elimination plan, 62
T
Targeted Capacity Expansion (TCE), under the Substance Abuse and Mental Health Administration, 168
Technical assistance
in Centers for Disease Control and Prevention programs, 165, 186
requests for public comment on, 186
Technological interventions, to prevent HIV infection, 156-157
Technologies, for developing HIV prevention investments, 7-8
Technology transfer
barriers at the community level to effective, 72-74
current efforts in prevention, 68-72
opportunities for improving prevention, 74-77
Territories. See States and territories
Testing
confidential, 22-23
by race and ethnicity, 30
Therapies, antiretroviral, 86-87
Time lapse, in diagnosis time for AIDS cases, 4, 81n
Tools, 80-89
alternative barrier methods, 83-86
antiretroviral therapies, 86-87
for developing HIV prevention investments, 7-8
promising new collaborations for, 89-91
promising new tools, 80-89
rapid testing methods for detecting HIV antibodies, 80-83
searching for new, 80-96
vaccines, 87-89
Tracking the epidemic, 14-25
HIV case reporting, 16-19
national AIDS surveillance system, 15
population-based HIV incidence estimation, 19-23
rationale for a national system of HIV surveillance, 16
Training, integrating HIV prevention early in health professionals’, 54
Transfusion-related infections, 35
Translating research into action, 6-7, 68-79
barriers to effective technology transfer at the community level, 72-74
current efforts in prevention technology transfer, 68-72
opportunities for improving prevention technology transfer, 74-77
Translation of prevention research into practice, requests for public comment on, 187
Transmission
modes of, 140-142
trends in, 140-142
Treatment of co-occurring conditions, interventions to prevent HIV infection, 156
Trends in the United States, 139-148
AIDS and co-occurring conditions, 147-148
changing demographic face of the epidemic, 142-146
modes of transmission, 140-142
U
Uganda, National AIDS Control Programme in, 105
United States
adult correctional systems in, 122
Standard Metropolitan Statistical Areas in, 41
trends in, 139-148
U.S. General Accounting Office (GAO), 34
U.S. Preventive Services Task Force Guide to Clinical Preventive Services, 51
V
VA. See Department of Veterans Affairs Health Care System
Vaccine research
under the National Institutes of Health, 167
return on investment issue, 88
Vaccine Research Center, 167
Vaccines, 87-89
advances in, 7
W
WHO Ad Hoc Committee on Health Research, 90
William and Flora Hewlett Foundation, 90
Women
AIDS cases in, 142-143
funding programs aimed at, 46, 189
health care settings utilized by, 56
programs for under the Ryan White CARE Act of 1990, 170
1999 Work Group Report on HIV Prevention Activities, 74
Workability, evaluating HIV prevention programs for, 192