A New Conversation...
September 3
2008
5:00pm ET
by Kevin
I have been reflecting on my experiences at the
XVII International AIDS Conference in Mexico City, which
concluded close to three weeks ago. As I walked the
conference hall, I could feel the amazing energy,
passion and commitment that this event brings together.
Once again, I was humbled and invigorated by the
selfless dedication of those committed to fighting the
global HIV pandemic.
There were so many powerful moments at the meeting. At
the opening ceremony, Keren Gonzalez, a poised
12-year-old girl from Honduras, spoke about her
experiences being infected with and affected by
HIV and her already three-year commitment to stopping
HIV. She edits the magazine, Infantil LLAVECITAS, for 8-
to 12-year-old children who are touched by HIV and AIDS.
Her moving story illustrated once again the importance
of involving and engaging all youth in real and
meaningful ways to stop this epidemic. It also
reinforced my own thoughts and commitment to the work
that remains to be done to create an AIDS-free
generation.
In this spirit, I post my first blog entry in hopes of
creating an online community where we can work together
to advance our HIV, STD, TB and hepatitis prevention
research and programs and inspire a collective
commitment to promoting and protecting health. A key
focus of this blog will be to discuss ways in which we
can move our prevention activities to be more than the
sum of their collective parts, by developing a
syndemic orientation that would focus on the
connections between health-related problems. It is
characterized by better collaboration between programs,
improved service integration at the client level, and
tackling health disparities by adopting and implementing
comprehensive and multi-level approaches to prevention.
In the United States, we are at a turning point. New
breakthrough technologies have provided us with the
clearest picture of the HIV epidemic to date. Previous
estimates of HIV incidence in the United States
suggested that there were approximately 40,000 new cases
of HIV each year. The most recent estimates in 2006
suggest that the epidemic is and has been higher than
previously known, at approximately 56,300 new HIV
infections annually. Although we are not seeing
increases in the number of new infections, these new
estimates confirm the critical need to build upon
prevention efforts in the African-American and Hispanic
communities, and revitalize efforts to reach men who
have sex with men.
Accelerating progress in the prevention of HIV and AIDS will require a
collective response at the individual, community and
national levels. There is an urgent need to address
factors that contribute to the spread of these diseases,
including poverty, inaccurate knowledge of HIV status,
high rates of other STDs, drug use and stigma. It is
critical that we focus on enhancing access to HIV
testing and other proven interventions, and continue
research to identify new interventions to address the
evolving needs of diverse populations.
Now is the time to sustain and accelerate individual and
community HIV prevention efforts to reach those most at
risk. Together, we can enhance our collective synergies
to prevent the spread of HIV/AIDS throughout the United
States. As Pedro Cahn, the Immediate Past President of the
International AIDS Society and the International AIDS Conference
Co-Chair, said at the opening ceremony: “We can - and we
must - do better.”
Submit a comment -
Comment Policy
Dr. Fenton,
I am an Infectious Disease Fellow in St Louis, MO and it is depressing to see the number of African American patients with HIV. A subgroup that seems to dominate my patient panel is MSM who are also African American. Due to the combined stigma of HIV and homosexuality this group is hard to reach. What kind of Public Health programs or research is geared towards this group???
Thank you,
Abayomi Agbebi
Posted by Abayomi Agbebi on Thursday, October 2, 2008 at 4:37 pm ET
Comment
Dr. Fenton,
I am a grant writer for an AIDS Service organization (ASO) in Florida. Our ASO has been looking for grants that deal with HIV/HCV co-infection, without success.
The State of Florida did have a HIV/HCV co-infection grant, but the amount of funding available simply was not enough to support a comprehensive HIV/HCV co-infection program.
Our ASO tried to “work the numbers,” but could not develop a workable program with the amount of funding available.
I would urge CDC to fund programs that deal with HIV/HCV co-infection.
Our local Ryan White medical clinic reports that 30% of their patients are co-infected with HCV.
Bill Thomas
Posted by Bill Thomas on Friday, September 19, 2008 at 7:22 pm ET
Comment
Dear all
Thank you all for your responses to my first blog post. Given my schedule, I am not able to respond to each posting. However, I have read your comments. Some of them have inspired me to look at the topics discussed with a new and different perspective. I appreciate your insight. Regards, Kevin
Posted by Dr. Kevin Fenton on Thursday, September 18, 2008 at 5:05 pm ET
Comment
Dr. Fenton,
I believe a national media campaign may work well, similar to the one launched to try and decrease tobacco use. I have noted a relative absence of TV advertisements and radio announcements discouraging the use of substances like tobacco, alcohol and other drugs the last few years. It is time to once again use the media and internet to target our youth and others. I believe this would work well for HIV and Hepatitis as well.
VG
Received from VGuillen, on Thursday, September 18, 2008 at 3:18 pm ET
Comment
Dr. Fenton,
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
Mr. Hooks,
Thank you for bringing these resources to our
reader’s attention. Our
hepatitis web site now
links to the Health Protection Perspectives
blog, so individuals seeking hepatitis
information can view the comments on my blog.
Regards, Kevin
Posted by Dr. Kevin Fenton on Thursday,
September 18, 2008 at 5:07 pm ET
Comment
Dr. Fenton,
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
Dr. Fenton,
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
Dr. Fenton,
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
Dr. Fenton,
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
Dr. Fenton,
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
Dr. Fenton and others,
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
Dr. Fenton,
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
Dr. Fenton,
Jeff Hoffman, Ph.D.,
Danya International, Inc.
Received from Jeff Hoffman, Ph.D. on Friday, September 5, 2008 at 12:57 am ET
Comment
Dr. Fenton,
Judy Sandeen, RN
Received from Judy Sandeen, RN on Thursday, September 4, 2008 at 10:58 pm ET
Comment
Dr. Fenton,
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
Dr. Fenton,
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
Dr. Fenton,
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
Dr. Fenton,
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
Dr. Fenton,
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
Dr. Fenton,
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
Dr. Fenton,
Jennie Anderson, AIDS.gov
Received from Jennie Anderson on Thursday, September 4, 2008 at 12:07 pm ET
Comment
Dr. Fenton,
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
Dr. Fenton,
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
Dear Ms Ricciardi –
Thank you for your comment. I asked one of the analysts on my team to help address your
comment. Here’s is the information she provided me.
NCHHSTP does not collect data on TB patients’ immigration
status, either legal or illegal; however, data are collected on
where a TB patient is born and if the patient is foreign-born,
or born within the United States. Foreign-born refers to persons
born outside the United States and its possessions and
dependencies.
For the past 14 years, the number of TB cases in foreign-born
persons remained virtually level, with
approximately 7,000 to
8,000 cases occurring each year, whereas the number in U.S.-born
persons decreased from more than 17,000 in 1993 to less than
5,500 in 2007. According the
2007 TB Surveillance Report, 13,299
TB cases were reported to CDC from the 50 states and the
District of Columbia. Fifty-eight percent of those cases
occurred in foreign-born persons. .
Moreover, NCHHSTP does collect data on whether a TB patient was
an inmate of a correctional facility at the time the TB
diagnostic evaluation was performed. In 2007, only
476 TB cases
were residents of correctional facility at time of their TB
diagnosis. According to the
Bureau of Justice Statistics, on
June 30, 2007,
almost 2.3 million prisoners were held in federal
or state prisons or in local jails.
Our Center does not collect data on infection control in
hospitals. However, I welcome you to visit CDC’s
Infection
Control in Healthcare Setting Web site, which has much
information on the subject.
Hope this information is helpful. Regards, Kevin
Posted by Dr. Kevin Fenton on Thursday, September 18, 2008 at
5:15 pm ET
Comment
Dr. Fenton,
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
Comment
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