Healthy People 2000 Consortium Meeting November 7, 1997

Summary of Breakout Group Discussion Concerning Priority Areas 18 and 19: HIV Infection and Sexually Transmitted Diseases

Introductions were made.

Eva Seiler and Joel Greenspan provided an overview of the purpose of the session and some background information on the proposed schedule and framework.

The following summarizes comments from the groups (HIV/STD) regarding health disparities, the HP 2010 framework, and objectives.

Comments on Eliminating Health Disparities vs. Reducing Health Disparities

• The question of how "elimination" will affect strategies was brought up. If elimination is the goal, it does bring up practical concerns of how to achieve the goal.
• The question of where you set the "bar" was raised. Does eliminating disparities mean you bring other populations up or reduce the expectations of those groups already close to or beyond the goal?
• It may be easier to achieve a population level objective, but we will have no idea how individual groups are doing (e.g., an overall goal of reducing syphilis could be achieved, but we will have no way of knowing what is happening to African American men in the South).
• There is much diversity even among States. People don't want to talk about a single issue across the board; they want to see what is happening in each group. Would it be possible to set an overall goal and report out individual (State/local) goals and achievement of those goals?
• Elimination as a goal with individual (State/local) objectives as a way to move toward the goal was suggested.
• It is good to have national goals, but if we have limited resources to achieve the goal, there needs to be a focus on those groups most impacted (target groups).
• If the goal is to eliminate health disparities within the current outlined disease groups, than it makes sense to have each work group (disease area) identify where the disparities lie (which populations) and create objectives to address the disparities among identified population groups.

Comments on Framework

• The group did not like the way the fan separated the chapters into "enabling goal sections." For example, HIV and STDs do not fall solely under "promote healthy behaviors." There are also care, access, and community prevention activities involved. The presentation (fan) should be designed in a way that demonstrates that the enabling goals are not mutually exclusive to the chapters listed above the goals.
• If the fan is a marketing tool, does it really convey the message we want, or is it just a laundry list? A marketing expert should be consulted to provide feedback on the fan.
• Many questions were raised about the structure of the HP 2010 process and who is involved in the process. It was suggested that additional efforts be made to include those providing clinical services (HMOs, PPOs, payors) as well as more local community groups and health departments. There were very few nongovernment participants at the table and the point was made that there needs to be some kind of a "connection" with community members in order to get more input and to help make the process work.
• The question of whether we should be looking at "disease areas" or "population groups (low income, age, etc.)" was raised. There is not one Federal agency charged with keeping data on all populations and that perhaps we should target groups not by disease area or population group, but by "risk group."
• Some of the Healthy People goals are similar or related to GPRA goals and that efforts at the agency level are being duplicated.
• The development guide was a bit overwhelming and perhaps in future publications an executive summary could be included.
• Not all members of the group agreed that the general section should be called "sexual health." A sexual health chapter does not include all means of HIV transmission. HIV objectives would also have to be listed under "substance abuse" and other areas to include transmission through injection drug use and other high risk behaviors that serve as precursors to the transmission of HIV/STDs.
• The idea of a "Reproductive Health Care" chapter could serve as an umbrella chapter for STDs, HIV and maternal health.

Comments on Objectives

Suggestions for new objectives

• All of the HP 2000 objectives are focused on primary prevention, and secondary prevention efforts should be addressed (e.g., cytomegalovirus prevention) in the 2010 objectives.
• Objectives related to (prevention of) disease progression and adherence to medication regimens were also suggested.
• An objective related to tracking time of a positive HIV test result to the time of treatment would be helpful.
• Access to treatment was suggested as a possible new objective: access to treatment; access to prescriptions and getting those prescriptions filled; access to counseling, testing and treatment for the incarcerated population.
• It was also suggested that an objective be developed that looked specifically at the age group 15 to 24 and HIV.
• An objective that tracks which States have authorized needle exchange legislation was suggested.
• Examining the relationship of HIV and STDs and measuring the co-infection rates was also suggested.
• A new objective was suggested that would monitor health outcomes among infants who acquired STDs in utero.
• Objectives that track screening of pregnant women for STDs in health services settings would be helpful for HP 2010.

Suggestions for changing or modifying HP 2000 Objectives

19.3 and 19.8 - This objective specifically looks at STDs among blacks. It was suggested that this be expanded to other groups.

It was suggested that an objective similar to 19.11 be included to measure the effectiveness of prevention efforts on the number reported viral STDs.

19.11 - A concern was raised that the goal to increase the proportion of clinics that provide onsite primary and secondary prevention is currently too low at 50%.

19.17 (18.11) - The question of whether to keep or modify this objective was raised. It was suggested that we keep this objective because more college students are seeking HIV testing and counseling and therefore, more information on HIV and STDs is being disseminated. However, there is no way to measure effectiveness of education being disseminated. It was suggested that it is more realistic to reach 90% of the college students who actually come into the clinics, as opposed to 90% of all students.

18.1 - The baseline data for this objective is provided both by percentage and by cases per 100,000. It was suggested that this data be presented in one uniform way. This objective will most likely be revised by the workgroup.

18.7 - There was a suggestion to move this objective to infectious diseases and include reducing the risk of transmission of other diseases like hepatitis.

Participants

Joel Greenspan, Facilitator, Centers for Disease Control and Prevention (lead, STD chapter)
Eva M. Seiler, Facilitator, Centers for Disease Control and Prevention (lead, HIV chapter)
Carmen Hernandez, Recorder, Centers for Disease Control and Prevention
Dave Brownell, Centers for Disease Control and Prevention
Joan Cates, American Social Health Association
Jeff Crowley, National Association of People With AIDS
Pat Fishback, National PTA
Ed Hutchins, Healthier People Network
Dorothy Kozlowski, National Alliance of Nurse Practitioners/ACHA
Alex Ross, Health Resources and Services Administration, HIV/AIDS Bureau
George Rogers, Department of Health and Human Services, Office of the Regional Health Administrator, Region V




Breakout Session List