Modifications to Objectives and Subobjectives

The following discussion highlights the modifications, including changes, additions, and deletions, to this focus area's objectives and subobjectives as a result of the midcourse review.

To reflect improvements in HIV/AIDS treatment, surveillance, and medical knowledge, modifications were made to 10 of the 18 objectives in this focus area. These modifications further explore improved ways of examining the HIV/AIDS epidemic. Two developmental objectives became measurable with the identification of a data source.

"Increase the proportion of sexually active persons who use condoms—males aged 18 to 49 years" (13-6b) was reworded to incorporate males 18 to 44 years to be consistent with the already measurable subobjective 13-6a for females ages 18 to 44 years and to coincide with the age of the sample in the data source, Survey of Men and Women 2002: The National Survey of Family Growth. This subobjective became measurable, and additional trend data are anticipated by the end of the decade.

Objective 13-16 was reworded to "increase the proportion of HIV-infected persons surviving more than 3 years after a diagnosis of AIDS." The objective became measurable because the CDC HIV/AIDS Surveillance System data accurately represent all States and Territories that report AIDS cases. The target is 88 percent, and the baseline is 83 percent of HIV-infected persons diagnosed with AIDS in 1998 were still living in 2002.

Three objectives and one subobjective (13-5, 13-15, 13-17a, and 13-18), which use the CDC HIV/AIDS Surveillance System as a data source, remained developmental, because not all States have in place confidential, name-based HIV/AIDS reporting systems and the data are not nationally representative. For this reason, AIDS case surveillance data are used as a surrogate for perinatal, adolescent, and HIV transmission. Consequently, these objectives were reworded to include the term HIV/AIDS instead of HIV infection. The new term more appropriately reflects the three categories of cases that refer to HIV infection: new diagnoses of HIV infection only, new diagnoses of HIV infection with later AIDS diagnoses, and concurrent diagnoses of HIV infection and AIDS. Two additional subobjectives (13-13a and b) remained developmental, with data anticipated from the new CDC HIV Medical Monitoring Project Morbidity Monitoring Survey.

Objective 13-5 was reworded to "reduce the number of new cases of HIV/AIDS diagnosed among adolescents and adults." This objective remained developmental at the midcourse review with data anticipated by the end of the decade.

Objective 13-15 was retained as developmental and revised to "increase the proportion of new HIV infections diagnosed before progression to AIDS." Objective 13-17 was expanded to include two subobjectives: "reduce the number of new cases of perinatally acquired HIV/AIDS diagnosed each year" (13-17a), and "reduce the number of new cases of perinatally acquired AIDS" (13-17b). Subobjective 13-17a was retained as developmental. Subobjective 13-17b became measurable with a baseline of 82 new cases of perinatally acquired AIDS in 2002, and a target of 75 was set.

Objective 13-18, formerly objective 25-8, was reworded to "reduce the number of new cases of HIV/AIDS diagnosed in adolescent and young females aged 13 to 24 years that are associated with heterosexual contact." It also remained developmental pending reporting of HIV/AIDS cases by all States.

Two subobjectives for increasing the proportion of HIV-infected persons aged 13 years and older who receive testing, treatment, and prophylaxis consistent with current Public Health Service (PHS) treatment guidelines were retained: viral load testing (13-13a) and tuberculin skin testing (13-13b). These subobjectives remained developmental, with data anticipated from the HIV Medical Monitoring Project Morbidity Monitoring Survey.

As stated in Healthy People 2010: "Most developmental objectives have a potential data source with a reasonable expectation of data points by the year 2004 to facilitate setting 2010 targets in the mid-decade review. Developmental objectives with no baseline at the midcourse will be dropped." Accordingly, at the midcourse review, four developmental objectives were deleted because they lacked a data source: knowledge of serostatus (13-7); HIV/AIDS, sexually transmitted disease (STD), and tuberculosis (TB) education in State prisons (13-9); HIV counseling and testing in State prisons (13-10); and screening for STDs and immunization for hepatitis B (13-12). However, HHS and the agencies that serve as the leads for the Healthy People 2010 initiative will consider ways to ensure these public health issues retain prominence despite their current lack of data.

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