The Centers for Disease Control and Prevention’s new initiative, Advancing HIV Prevention: New Strategies for a Changing Epidemic, is aimed at reducing barriers to early diagnosis of HIV infection and, if positive, increasing access to quality medical care, treatment, and ongoing prevention services. The initiative emphasizes the use of proven public health approaches to reduce the incidence and spread of disease. As with other sexually transmitted diseases (STDs) or any other public health concern, principles applied to prevent disease and its spread will be used, including appropriate routine screening, identification of new cases, partner counseling and referral services, and increased availability of sustained treatment and prevention services for those infected.¹

CDC’s HIV prevention activities over the past two decades have focused on helping uninfected persons at high risk for HIV change and maintain behaviors to keep them uninfected. Despite these efforts, the number of new HIV infections is estimated to have remained stable and the number of persons living with HIV continues to increase.

The new initiative capitalizes on new rapid test technologies, interventions that bring persons unaware of their HIV status to HIV testing, and behavioral interventions that provide prevention skills to persons living with HIV.

The next decade promises new hope as three primary areas of HIV prevention are emphasized:

• Early detection of persons who are HIV positive and referral to care services
• Prevention interventions with persons living with HIV
• Prevention with persons who are at high risk for HIV infection

CDC, other federal agencies, and the HIV prevention community will continue their work to help ensure prevention efforts in these three areas are sustained and reenergized as an integrated approach. This broad scope will bring the best prevention science to the fight against HIV/AIDS to reduce HIV transmission.

An emphasis on greater access to testing and on providing prevention and care services for persons living with HIV can reduce new infections and lead to reductions in HIVassociated morbidity and mortality.^2,3 In addition, simplifying prenatal and other testing procedures can lead to more effective use of CDC resources to help prevent perinatal and other HIV transmission.

The initiative consists of four key strategies:

• Make HIV testing a routine part of medical care. CDC will work with professional medical associations and other partners to ensure that all healthcare providers include HIV testing, when indicated, as part of routine medical care on the same voluntary basis as other diagnostic and screening tests.
• Implement new models for diagnosing HIV infections outside medical settings. CDC will fund new demonstration projects using OraQuick®, a rapid HIV test recently approved by the U.S. Food and Drug Administration for use in clinical and non-clinical settings, to increase access to early diagnosis and referral for treatment and prevention services in high-HIV prevalence settings, including correctional facilities.
• Prevent new infections by working with persons diagnosed with HIV and their partners. CDC in collaboration with the Health Resources and Services Administration (HRSA), the National Institutes of Health, and the HIV Medical Association of the Infectious Diseases Society of America, has published the Recommendations for Incorporating HIV Prevention into the Medical Care of Persons with HIV Infection. These groups will work to disseminate this document to a variety of health care providers.
• Further decrease perinatal HIV transmission. CDC will promote recommendations and guidance for routine HIV testing of all pregnant women, and, as a safety net, for the routine screening of any infant whose mother was not screened. CDC will work with prevention partners, including the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Nurse-Midwives, to disseminate the recommendations and support their implementation.

CDC will monitor the implementation of these new activities through several systems, including new performance indicators for state and local health departments and CBOs, monitoring HIV incidence, and expanding its surveillance system by implementing a national behavioral surveillance system.

References

1. CDC. Advancing HIV prevention: New strategies for a changing epidemic. MMWR 2003;52:329-332
2. Janssen RS, Holtgrave DR, Valdiserri RO, Shepherd M, Gayle HD, DeCock KM. The serostatus approach to fighting the HIV epidemic: Prevention strategies for infected individuals. Am J Pub Health 2001;91:1019–1024.
3. Institute of Medicine. No time to lose: Getting more from HIV Prevention. Washington, DC: National Academy Press, 2001.

For more information on CDC’s New Initiative, visit the Divisions of HIV/AIDS Web site on Advancing HIV Prevention www.cdc.gov/hiv/prev_prog/ahp/.

For information on HIV/AIDS, call CDC-INFO 24 Hours/Day at 1-800-CDC-INFO (232-4636), 1-888-232-6348 (TTY), in English, en Español.

Call CDC’s National Prevention Information Network at 1-800-458-5231 for information and materials on HIV/AIDS.