Wednesday
September 3
2008
5:00pm ET
by Kevin

Good Day, I was browsing the HCV area with interest only to find that the limited methods of transmission listed is inadequate. "Hepatitis C is usually spread when blood from a person infected with the hepatitis C virus enters the body of someone who is not infected. Most people become infected with the hepatitis C virus by sharing needles or other equipment to inject drugs."

This doesn't even begin to scratch the surface of methods HCV can be transmitted and does a real injustice to the public in general.

As I'm sure your aware, HCV has been called the "Silent Epidemic" and is it any wonder why? As a government agency who's duty is to alert the public and keep them out of harms way, I feel you should make a lot more noise about HCV. You should also insure the entire list of transmission methods are shown and don't forget the Veteran in the list of folks at risk.

IV drug use, although a valid method of transmission if needles are shared is by no means the most prevalent method out here. There is an entire generation of folks, from the 60's (Nam) era, that were infected, while serving in the military and don't know it, thus another source of infection. If you don't know how can you take the precautions so as not to spread the virus?

I would ask that you go to http://www.hcvets.com/ and http://www.hcvets.com/data/transmission_methods/transmission.htm for more precise information. I would also ask that this be added to your information pertaining to HCV. We really need to come to terms with this epidemic and put an end to it.

Thank You for your time,
Harry Hooks
Forum manager
http://forums.delphiforums.com/hcvets/start 

Received from Harry Hooks, on Tuesday, September 16, 2008 at 10:09 pm ET
Comment

The current HIV incidence data is a clarion call for expanded leadership and creative fresh approaches in renewed HIV prevention efforts. We understand that sustained HIV prevention is not easy, but we have learned that prevention messages must be sustained from a variety of channels. To begin, we would urge that you consider systematically capturing CDC institutional memory about successful primary prevention programming utilized successfully in the past. Combined with renewed intervention efforts based on science to reduce new infections and expanding treatment and prevention efforts, it is our belief that the epidemic in the United States can be reduced successfully.

Now, trusted sources of information about HIV prevention may be more important than ever. Absent an effective microbicide or vaccine, it is the only thing we have.

As the former CDC project officer for the only nationally standardized training program by the American Red Cross with culturally specific programming for African Americans and Hispanics, general public and workplace, we found that partnerships for prevention were critical. With $35 million plus from taxpayers to produce the training by the Red Cross and rollout over five years, this training was a premier activity that “mainstreamed” HIV prevention messages from a trusted source at a community level. I urge you to consider updating and restoring this critical community resource and look for other community resources.

Through Red Cross and other partners in the late 1980s and early 1990s, we at CDC learned the power of reinforcing messages with trusted partners to stem the epidemic. With other key partners from the business, faith based and non-profit communities, CDC’s efforts were enhanced by these trusted gatekeepers across the U.S. It is our understanding that the Red Cross program efforts and other key national partners have not been fully funded by CDC in recent years, nor have prevention messages from CDC always been consistent. In particular, CDC messages about the effectiveness of condoms based on science has been confusing. We urge you to refocus these efforts on a community level to compliment activities that focus on individual level behavior change.

Delivering key prevention messages and programs with collaborating partners provided confidence in government efforts in a way that the government could not. From 1989-1995, CDC leadership found that a strong partnership program with key national partners proved successful to reinforcing and enhancing CDC’s efforts with state and local health departments and community based organizations. Unfortunately, working consistently with national partners in novel ways by CDC has been waning over the last seven years or leveraging CDC’s partners systematically with other cross cutting programmatic areas has not occurred.

These new incidence data provide even more incentives and greater urgency for collaborative partnerships to find new, creative ways to reach populations impacted by HIV, including African Americans and men who have sex with men. We urge you to consider strengthening inputs from those partnerships with key strategic planning tied to realistic resources to produce substantial and long lasting efforts in HIV prevention. With progress in testing, dramatic changes in treatments, intervention research and new incidence technology, surely identified partners could be engaged to create and leverage such prevention efforts to stop the HIV epidemic in the U.S.

I urge you to capture this CDC institutional memory, find fresh approaches with a critical mass of partners and achieve consensus upon the fundamentals of HIV prevention to produce sustained, multi-channeled activities that will ultimately stem the tide of the HIV epidemic in the U.S.

Thank you for this novel opportunity to provide inputs to you. We hope that it is the beginining of fresh approaches to a persistent need for multiple channels of information about HIV prevention to affected individuals and communities at every level.

Margaret Scarlett, retired CDC HIV program
President and CEO Scarlett Consulting International

Received from Margaret Scarlett, on Monday, September 15, 2008 at 7:23 pm ET
Comment

Why don't we have a blanketed policy for just testing everybody in the country? When you go in the military they test you. With testing we identified those persons that are infected. This could save money and lives and curtail the spread of the disease from those who do not know they are infected. The allocation of money and resources can be targeted more appropriately.

Received from Mark Stevens, on Friday, September 12, 2008 at 10:41 pm ET
Comment

How widespread is the phenomenon?... of the strategy of "Let's get tested TOGETHER BEFORE we have sex, for A VARIETY of STDs." Sexual health checkups reduce ambiguity and can be like anything else POTENTIAL sex partners might do together.

Received from Don Saklad, on Friday, September 12, 2008 at 10:49 am ET
Comment

NICELY done ---you have LEAPT into the new millennium of technology very professionally!

Lou Ann Weil
Director, Statewide Cancer Screening Services
Adagio Health

Received from Lou Ann Weil, on Tuesday, September 11, 2008 at 7:53 am ET
Comment

I also am pleased to see dialogue between CDC and the public on issues around HIV/AIDS. I would certainly like to see more monies and efforts spent on organizing and building community support for primary prevention in special sub-populations such as African Americans in the rural South. I strongly advocate for continued use of clergy as natural and strong leaders in these efforts. I know that the CDC has begun such efforts, but trickle down into small rural Southern communities has not yet happened. Looking forward to continued dialogue.

Pamela Payne Foster, MD, MPH

Author of Is There a Balm in Black America?

Received from Pamela Payne-Foster, on Tuesday, September 9, 2008 at 12:16 pm ET
Comment

We have seen an increase in internet partnering among MSM populations. HIV infection is most prevalent in the MSM population of our small urban/rural community. Has anyone found a successful HIV prevention plan that targets MSM populations that are using the internet to hook up? Are there any evidence-based prevention programs that have been proven to be effective in addressing this issue?

Nikki Sakata, MPH

Received from Nikole Sakata, on Friday, September 5, 2008 at 1:50 pm ET
Comment

Congrats on the new blog. It is in line with my research area, specifically HIV/AIDS discussions, and African American dialog of the crisis in "virtual third places." Please review the Op-Ed that I wrote and published in the Christian Science Monitor and Yahoo! News regarding blogs and third places, such as yours. It provides backing for the task you are currently undertaking. If it is possible, please link the Op-Ed to your blog, or have me write a piece for publication on your blog.

Web URL: http://www.csmonitor.com/2008/0731/p09s01-coop.html

Best,

C. Frank Igwe, Ph.D.
College of Information Sciences and Technology
The Pennsylvania State University

Received from C. Frank Igwe, Ph.D., on Friday, September 5, 2008 at 2:47 am ET
Comment

First, I would like to commend you on the direct and straightforward way that you have handled the recent release of the revised HIV incidence estimates in the U.S. Your candid approach and leadership on this issue will help all of us to unite our energies to find innovative and effective solutions to this ongoing crisis and help to foster a greater sense of urgency. Clearly, we have done a terribly inadequate job in reducing the numbers of new infections - especially among African Americans, Hispanics and men who have sex with men. We do need to promote an aggressive national strategy that educates the public at large and addresses the specific needs, concerns and issues relevant to those highest at risk for becoming infected or who are already infected. We have learned a great deal about what works and what doesn't work in HIV prevention - highly targeted and multi-faceted outreach; widespread testing and counseling promotion; condom promotion and availability; circumcision, among other strategies in combination. The key is to fund these efforts sufficiently and ensure effective and accountable implementation. We all need to work together to advocate for funding these efforts much more substantially and to ensure that we do once and for all dramatically reduce HIV infection rates in this country, as well as around the world.

Jeff Hoffman, Ph.D.,
Danya International, Inc.

Received from Jeff Hoffman, Ph.D., on Friday, September 5, 2008 at 12:57 am ET
Comment

I welcome this new conversation. For the past 17 years I have been the advisor for an HIV prevention peer education group at the college level. Those students are trained using the Red Cross prevention curriculum, which lost its CDC funding several years ago, and as a result, is less and less available. It is an excellent curriculum which is effective in its approach. I wonder if there's any possibility of taking another look at the decision to cut that funding?

Judy Sandeen, RN

Received from Judy Sandeen, RN, on Thursday, September 4, 2008 at 10:58 pm ET
Comment

Thank you for publicly endorsing the creation of a National AIDS Strategy in the sessions you spoke at in Mexico City. I agree we are at a turning point in the fight against HIV/AIDS in the U.S. Achieving greater progress against the epidemic will require a new, national commitment to a coordinate, results-oriented approach to HIV. We need a better roadmap that employs every resource at our disposal and a goal of significantly reducing new HIV infections in the U.S. and improving survival and health outcomes for those of us living with HIV/AIDS. This is a job that is greater than the scope of the CDC and will require cooperation from a broad array of federal agencies, government officials, and community stakeholders.

Finally, I want to thank Richard Wolitski, CDC's acting HIV prevention director, for eloquently addressing take-home messages from the Mexico City conference in a taped interview. Dr. Wolitski's candor and compassion is greatly appreciated.

All the best,

David Ernesto Munar
AIDS Foundation of Chicago

Received from David Ernesto Munar, on Friday, September 4, 2008 at 8:41 pm ET
Comment

Thank you very much for creating a dynamic vehicle to advance discourse and unify collective efforts to prevent and treat HIV, STDs, Hepatitis and TB. All sectors – NGOs, Federal Agencies, Elected Officials, Philanthropic Community, Corporations, Academia and myriad others - have distinct roles, resources and responsibilities in creating and implementing the most efficacious prevention, intervention and treatment programs. The National Association of People with AIDS applauds your innovative approach to leveraging each sectors unique resources and potentiate our collective work.

Thank you.

Respectfully,

Tom Kujawski
Vice President of Development
NAPWA

Received from Tom Kujawski, on Thursday, September 4, 2008 at 7:48 pm ET
Comment

A recent article in the Washington Post that spoke of the disproportionate infection rates among Africans residing in the United States reminded me that we are still not reaching those most at risk, and we have been providing an ineffective message to those we have reached for many years.

The fact that there are any new infections at all points to a failing within all of public health to adequately reach and motivate the communities most at risk with messages that are meaningful and motivating to them.

Programs must be great listeners, before they can be great talkers and we all must understand that for many the abstinence and condom conversations will not be effective and may actually, ultimately do more harm than good, turn away many that for their own reasons have decided that condoms are not for them.

We must also learn to be good marketers and teachers. Marketers that can sell the advantages of staying healthy and motivate those most at risk to care about themselves and their partners enough to take precautions. Marketers that can teach those at risk how to create appropriate sexual boundaries and stick to them at all times. Teachers that can have frank, detailed conversations that talk about risk reduction techniques and ways to enhance the sexual experience while being safe at the same time. Teachers that meet each individual where they are physically, mentally, sexually, and spiritually. HIV is a disease that affects the whole person, prevention must address the whole person as well.

Public Health has traditionally been its own unique entity following its own self-created business model. The rates of infection prove that we cannot continue to conduct business as usual.

Stephan Adelson
Executive Director
Internet Interventions Incorporated

Received from Stephan Adelson, on Thursday, September 4, 2008 at 6:04 pm ET
Comment

Thank you for this new website and opportunity for dialogue.

Being as how the number one way to avoid HIV/AIDS/STDs and unwanted teen pregnancy is abstinence, why is there so much hostility to medically accurate authentic abstinence programs?

Once one has contracted HIV, are they not advised to reduce their partners or abstain?

Why are we not more proactive to at least put more serious support for this as an added component to the "safe" sex message?

Regards,
Linda H.

Received from Linda Haft, on Thursday, September 4, 2008 at 5:44 pm ET
Comment

You say that HIV incidence hasn't been increasing, but it's my understanding that within the US, there have been recent increases in the MSM (men who have sex with men) populations, especially among black MSM. Disinhibition fostered by the new highly effective treatments and by falling attention to HIV/AIDS amongst the media as other threats (West Nile Virus, SARS, Bird Flu, the wars in Asia and the middle east, and the economy) have arisen have not only resulted in increasing risk behavior in MSM in the US, but increasing rates of infection have been identified in other countries in this population which remains highly stigmatized throughout most of the world.

Can the CDC document whether federal and local resources to combat HIV transmission among MSM are proportionate to their contribution to the problem? I see next to nothing that the feds have done to specifically market the MSM problem or its solutions to MSM.
Thanks for initiating this set of conversations.

Robert W. Wood MD
Director, HIV/AIDS Program
Public Health - Seattle & King County

Received from Robert W. Wood, MD, on Thursday, September 4, 2008 at 5:35 pm ET
Comment

Thank you for beginning this blog and for your clear and thorough presentations of the new U.S. Surveillance at the IAC in Mexico City. I look forward to following your postings and the discourse that they will generate.

One of my key take homes from the conference was the question of “evidence” when it comes to HIV Prevention interventions and the monitoring of our efforts. We cannot wait for perfect evidence, and we must find ways of valuing and funding more community driven responses. The call to scale up access to HIV prevention throughout the world, including inside the United States, was the loudest collective cry I heard at the IAC. In the U.S., we have a “concentrated” epidemic primarily located in several vulnerable sub-populations, as opposed to a “generalised” epidemic sustained in large numbers by the entire population. In such an epidemic as the one in the U.S., we need more behavioral interventions to supplement biomedical and technical prevention research. I know the CDC works hard to bring effective individual and group interventions targeting those most at risk for contracting or transmitting HIV, and we need more of them. In concert with these efforts, we must do more to bring community level interventions to effect positive health seeking norms in targeted communities, and national campaigns to fight stigma and discrimination around HIV and homophobia. As you state, we must do better as a country. I know you agree we must finally develop a clear, truly national plan to stem the epidemic by scaling up HIV prevention efforts. I value your collaboration and leadership in inching us closer to a day when we have a clearer, more comprehensive and more fully coordinated course to chart together.

Eric Altman
Director, Research and Evaluation
Gay Men’s Health Crisis (GMHC)
New York City

Received from Eric Altman, on Thursday, September 4, 2008 at 5:31 pm ET
Comment

We laud you for using this new media tool as a forum to have this important dialogue about reducing health disparities and improving program collaboration and integration. As you mentioned in this post, with the recent release of the new CDC HIV incidence data we are at a critical "turning point." At AIDS.gov we're particularly interested in how government and non-governmental agencies can use new media tools to help inform the public, providers, and policy makers to respond to HIV/AIDS especially given the latest INCIDENCE numbers; and invite you to join the conversation about this on our blog. Again, we commend your efforts with this new blog and look forward to following it!

Jennie Anderson, AIDS.gov

Received from Jennie Anderson, on Thursday, September 4, 2008 at 12:07 pm ET
Comment

I have for years been pushing for age group efforts to fight HIV here in Georgia. Being a member of the CPG where only risk group efforts have be seen as being of importance has at best been frustrating. We have determined that 31% of those seeking services from service groups are between the ages of 13 to 17 and this is the largest current group.

CDC can be important in a movement to move away from the box of risk factor determination of funding to one that reflects the current state of the epidemic. The other STDs have been informing us for years about who is having the most unsafe sex. I think an all out effort to focus on the 13 to 17 age group will result in fewer infections of all STDs including HIV.

I observed the efforts of a local university to try to impact self esteem problems of young women 15 to 18 years of age. When they determined that they needed to expand their focus they moved the age group focus to 15 to 21. I protested, to no avail, that they needed to focus on the 12 to 18 year age group. We have to cut off this disease at the earliest possible time and education and yes testing should be approached like HBV.

Received from John Hopkins, on Wednesday, September 3, 2008 at 8:21 pm ET
Comment

I have heard that jail and prison inmates have more exposure to TB, and also possibly illegal immigrants.
I believe that our local hospitals admit patients whoever they are (higher exposure group) and mix them with the general population of other patients. Could this contribute in any way?

Received from Melissa Ricciardi, on Wednesday, September 3, 2008 at 7:44 pm ET
Comment

I am extremely pleased to see this blog, Dr. Fenton. "To do better" one risk factor that must be included is child and adult sexual abuse and intimate partner violence for HIV/AIDS and STIs.

Tasneem Ismailji MD, MPH

Received from Tasneed Ismailji, MD, MPH on Wednesday, September 3, 2008 at 5:59 pm ET
Comment