Tracking the Epidemic

CDC’s HIV/AIDS surveillance system is the nation’s source for key information used to track the epidemic. CDC funds and assists state and local health departments, which collect information about cases of HIV and AIDS and related risk behaviors. Health departments in turn report their data to CDC so that information from around the country can be analyzed to determine who is being affected and why.

CDC carefully monitors the status of HIV and AIDS by race, risk group, and gender, enabling communities to base public health strategies on the best possible understanding of the epidemic. This effort includes HIV and AIDS case reporting, and systems to estimate HIV incidence and monitor trends in risk behavior. In addition, CDC has recently initiated behavioral surveillance for the three groups at highest risk for acquiring HIV infection: MSM, IDU, and high-risk heterosexuals. The ultimate surveillance goal is a nationwide system that combines information on AIDS cases, new HIV infections, and behaviors and characteristics of people at high risk so that CDC can monitor the epidemic and target HIV prevention funding to where it is needed the most.

Identifying Causes & Solutions

CDC conducts extensive biomedical and behavioral research to better understand the complex factors that lead to HIV infection and to identify effective approaches to prevent infection. Priorities for HIV research include research related to diagnostic tests, microbicides, vaccines, and behavioral research focused on eliminating health disparities. Prior to the approval of the OraQuick HIV rapid test, CDC was involved in studies of the test’s accuracy as well as how the test could be used in certain settings. CDC is also actively involved in research to identify and test potential HIV microbicides. Most recently, CDC has initiated trials investigating the safety and efficacy of the prophylactic use of tenofovir, an anti-retroviral medication for use in preventing HIV infection.

CDC’s HIV vaccine research focuses on conducting and evaluating HIV vaccine trials in the United States and internationally. CDC also supports behavioral research projects to investigate health disparities associated with HIV prevention as well as to improve prevention efforts for high-risk populations.

Implementing Prevention Programs

The primary component in CDC’s fight against HIV/AIDS is the support and funding of HIV prevention programs. Programs consist of interventions intended to eliminate or reduce risky behavior and improve the health of the people served. CDC provides funding for state and local health departments as well as for CBOs to conduct HIV prevention programs with at-risk populations and in a variety of settings across the nation. All prevention programs funded by CDC are designed to meet the cultural needs, expectations, and values of the populations they serve. In addition, CDC helps to ensure that available prevention funding goes to those who need it the most by involving affected communities in the HIV prevention community planning process. Through the community planning process, communities prioritize populations to be served.

Key prevention strategies include: 

• HIV prevention counseling, testing, and referral services – Individuals at risk for HIV should be offered counseling regarding methods to eliminate or reduce their risk and testing so that they can be aware of their status and take steps to protect their own health and that of their partners. Recently available rapid tests provide the opportunity to provide tests results quickly. CDC issues guidelines that are used to develop counseling, testing and referral services in traditional and non-traditional settings and provides financial support for counseling and testing services provided at publicly funded clinics. In addition, CDC is developing guidelines for screening for HIV in health care settings. 

• Partner notification, including partner counseling and referral services (PCRS) with strong linkages to prevention and treatment/care services – Sexual or needle-sharing partners of HIV-infected persons have been exposed to HIV and are at-risk of being infected. Partner notification services locate these individuals based on information provided by the patient and provide counseling and education about the exposure as well as services to prevent infection or, if infected, linkages to care. CDC issues guidance on conducting PCRS and provides funding to state, local, and CBOs to ensure that PCRS is a high-priority and that services are offered to all HIV-infected persons. 

• Prevention for high-risk populations – Prevention efforts for high-risk populations, including HIV-infected persons, are critical to reducing the spread of HIV. Efforts ensure that those at highest risk of acquiring or transmitting the virus are given the tools necessary to protect themselves and others. CDC supports prevention services for persons infected with HIV/AIDS and other high-risk populations. In addition, CDC encourages all grantees to work with the primary health care clinics in their communities to integrate HIV prevention services into care and treatment services. 

• Health education and risk reduction (HE/RR) activities – Health education is a powerful tool in the prevention of HIV. HE/RR services include individual, group, community and structural interventions as well as prevention case management and outreach for high-risk HIV-negative and HIV-positive persons. They also include health communication and public information programs for at-risk populations and the general public. CDC supports focused health communications campaigns directly and provides funding for state and local health departments and CBOs to offer HE/RR services focused on those most at-risk of transmitting or acquiring HIV infection.

• Perinatal transmission prevention – When the HIV status of a pregnant woman is known, treatment of the woman and her infant and other preventive measures can substantially reduce the risk of HIV transmission to the infant. CDC provides funding for state and local health departments to work with all health-care providers to promote routine, universal HIV screening of all of their pregnant patients. In addition, CDC grantees work with organizations involved in prenatal and postnatal care for HIV-infected women to ensure that appropriate HIV prevention counseling, testing, and therapies are provided to reduce the risk of perinatal transmission.

• School-based HIV Prevention – Schools have a critical role to play in promoting the health and safety of young people and helping them establish lifelong healthy behavior patterns. CDC’s school-based HIV prevention program support 47 state education agencies, 18 large city education agencies, and 42 national non-governmental organizations to help set up school health programs that provide young people with skills and information to avoid or reduce behaviors that put them at risk for HIV infection. These programs are tailored to community norms.

Building Capacity of State & Local Programs

CDC works to ensure that organizations implementing HIV prevention programs on the state and local level are equipped with the information and training necessary to implement effective programs and build long term capacity for prevention in their communities. To build the capacity of its state and CBO partners to prevent HIV, CDC: 1) supports national meetings and satellite broadcasts as a forum for sharing new ideas and best practices; 2) funds non-governmental organizations to provide training and materials; 3) provides direct technical assistance to CBOs and health departments; and 4) synthesizes and disseminates information on science-based interventions.

Program Evaluation and Policy Development

Evaluation is an essential component of comprehensive HIV prevention. CDC works to identify and fund science-based interventions with proven effectiveness. All programs funded by CDC are required to develop evaluation plans and activities, establish performance indicators, and target activities to those persons living with HIV/AIDS and those at highest risk for HIV acquisition and transmission. One of the most significant actions to strengthen the assessment of program impact and effectiveness in reducing HIV infections is CDC’s Program Evaluation and Monitoring System (PEMS). PEMS will improve CDC’s ability to monitor, evaluate, and coordinate HIV prevention programs and ensure that timely and verifiable data are available for use by both grantees and CDC.

In addition to evaluation activities, CDC conducts policy research to identify critical policy-related questions, particularly legislative statutes at the local, state, or national level that hinder or strengthen HIV prevention programs. Using best practices and available research, CDC also helps to set prevention policy at the national level. CDC is particularly involved in developing and recommending policies that would facilitate comprehensive HIV prevention programs. For example, based on available information about effective screening strategies to prevent perinatal HIV transmission, CDC has advised that physicians use the “opt-out” testing approach for pregnant women. Under this approach, pregnant women are notified that an HIV test will be routinely included in the standard battery of prenatal tests for all pregnant women, but they can decline HIV testing. Recently, CDC presented an assessment of policies and regulations related to the opt-out approach and other recent HIV prevention recommendations in a national forum. This information can be used by state and local governments as they examine their own prevention policies.