AFC Calls New Initiative Significant for HIV-Positive
People, Wrong Direction for High-Risk Populations

The AIDS Foundation of Chicago (AFC) today commended a new initiative by the CDC to link greater numbers of HIV-positive people to medical care and prevention, but objected strenuously to several provisions that will hamper efforts to help high-risk individuals remain HIV uninfected.

"The new initiative is, on the one hand, very exciting and on the other hand very troubling," said AFC executive director Mark Ishaug. "While the CDC is right to redouble efforts helping HIV-positive people receive needed medical care and support in preventing new infections, its apparent retreat on counseling and risk-reduction services-such as condom distribution and outreach programs-represents a significant step backwards in our efforts to help high-risk communities respond to the AIDS crisis."

CDC officials unveiled the new initiative, called "Advancing HIV Prevention: New Strategies for a Changing Epidemic," in a special press briefing held today and in a published report in the April 18, 2003 edition of MMWR. The announcement surprised many AIDS advocates and government advisors, including the CDC/HRSA HIV/AIDS Advisory Committee, that had not been consulted about the initiative.

According to CDC officials, nearly a quarter of the $636 million appropriated in FY03 for domestic HIV prevention activities will focus on four priority areas: making HIV testing a routine part of medical care; using rapid HIV tests in non-medical settings; engaging HIV-positive people and their partners in care, prevention, and testing services; and establishing HIV testing for pregnant woman without requiring informed consent or counseling.

The initiative includes no new funds to expand HIV prevention and care activities. In fact, the initiative will supplant a portion of CDC funds currently supporting community and structural interventions in high-risk communities.

"Successfully reaching thousands of people with HIV/AIDS and linking them to needed services will be extremely difficult without increased funding for our nation's overburdened prevention, testing, and care systems," said AFC associate director David Munar. "Across the country, CARE Act-funded pharmaceutical assistance, medical care, and support service programs are above capacity and struggling to meet current needs. Without a financial commitment to expand funding, more low-income and uninsured people will become HIV-positive and be forced to forgo healthcare and other vital services."

The focus on HIV-positive people for HIV prevention is significant. AIDS advocates have long argued for increased attention to the prevention needs of HIV-positive people. Responding to these needs, AFC launched a demonstration project last year to support seven prevention and care integration projects in metropolitan Chicago, which builds on CDC's SAFE Initiative and programs supported by the Chicago Department of Public Health. How CDC's new initiative differs from past activities working with HIV-positive people remains to be seen.

CDC Endorses "Opt Out"

Striking among the announcement's themes were indications of CDC's willingness to forgo counseling, targeted HIV prevention education, and risk reduction services-proven strategies to reduce HIV transmission-in exchange for expanded testing and increased identification of people with HIV disease.

"CDC will promote adoption of simplified HIV-testing procedures in medical settings that do not require prevention counseling before testing," say CDC officials in this week's MMWR. Under this recommendation, thousands of people who are HIV-negative but who are at-risk for HIV will be tested and will receive little or no prevention education. For at least some of these individuals, education about HIV will be offered only after they have tested HIV-positive.

The CDC has designed special rules to apply for pregnant women. Under the CDC's recommendation, pregnant women will be tested for HIV unless they specifically "opt-out" or refuse testing. In other words, the CDC has chosen to abandon the principle that a pregnant woman, like anyone else, has a right to provide informed consent before being tested for HIV.

Last month, the AIDS Foundation of Chicago and the AIDS Legal Council of Chicago delivered a letter to the CDC signed by 21 local and national AIDS organizations urging the CDC to reinforce, not diminish, the importance of pre-test counseling and informed consent. Without counseling and informed consent, HIV-negative pregnant women who, by definition are engaging in unprotected sex and therefore are at risk for HIV, will not receive vital information about HIV/AIDS and ways to prevent infection. In addition, HIV testing without informed consent risks further alienating women who are already outside the healthcare system and whose trust is needed to assure continuity of care for them and their children.

The initiative will also pull back on community and structural interventions, such as condom and sterile syringe education, outreach activities, and risk-reduction counseling and skills-building services, that are being provided by community-based organizations directly funded by CDC. CDC will continue to allow state and local health departments to use federal funds to support such activities, so long as they prioritize providing services to HIV-positive people. AFC fears that the net result will be an over-reliance on a medical model to prevent new case of HIV and leave at-risk populations, including people of color, youth, men who have sex with men, and injection drug users, with far fewer available HIV prevention education services.

"Preventing HIV infection is everyone's responsibility," said Mark Ishaug. "Both HIV-positive and HIV-negative individuals need accurate and science-based HIV prevention education and access to prevention supplies, such as condoms and sterile syringes, so they may safeguard their health and the health of others."

"Testing alone is not HIV prevention," said David Munar. "We fear this new paradigm will alienate youth and people of color who already are disenfranchised from the healthcare system."

###

The AIDS Foundation of Chicago (AFC) is Illinois' principal advocate for people living with and at risk for HIV disease. Established in 1985 to provide central leadership in the fight against the epidemic, AFC promotes sound HIV/AIDS public policy, funds HIV/AIDS care and prevention projects, and through its Service Providers Council, helps to coordinate the delivery of essential HIV/AIDS services.

Coalition Response Letter to CDC Guidelines