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Wednesday
September 3
2008
5:00pm ET
by Kevin
A New Conversation...
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,
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/![link to non-governmental site](https://webarchive.library.unt.edu/web/20080917220628im_/http://www.cdc.gov/nchhstp/TemplateImages/red.gif)
and
http://www.hcvets.com/data/transmission_methods/transmission.htm![link to non-governmental site](https://webarchive.library.unt.edu/web/20080917220628im_/http://www.cdc.gov/nchhstp/TemplateImages/red.gif)
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
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,
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
Dr. Fenton,
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
Dr. Fenton,
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
Dr. Fenton,
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. ![link to non-governmental site](https://webarchive.library.unt.edu/web/20080917220628im_/http://www.cdc.gov/nchhstp/TemplateImages/red.gif)
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 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
Dr. Fenton,
A recent
article in the Washington Post![link to non-governmental site](https://webarchive.library.unt.edu/web/20080917220628im_/http://www.cdc.gov/nchhstp/TemplateImages/red.gif) 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
Dr. Fenton,
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
Dr. Fenton,
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
Dr. Fenton,
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
Dr. Fenton,
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
Dr. Fenton,
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
Dr. Fenton,
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
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
Received from Tasneed Ismailji, MD, MPH on
Wednesday, September 3, 2008 at 5:59 pm ET
Comment
Last
Modified:
09/17/2008
Last Reviewed: 09/03/2008
Content Source:
National Center for HIV/AIDS, Viral
Hepatitis, STD, and TB Prevention |