NOT-SO-GREAT EXPECTATIONS

From Housing Work's AIDS Issues Update

May 11, 2007

The Bush administration shocks AIDS advocates by abandoning its U.S. HIV-prevention goals; CDC official admits infections likely already on the rise.

Gerberding throws her hands up.

The same week that President Clinton brokered a groundbreaking deal on generic AIDS meds for developing countries, the Bush administration threw up its hands when it comes to stopping HIV in the U.S.

The Centers for Disease Control stunned attendees at its CDC/HRSA Advisory Council (CHAC) meeting with the last-minute announcement of its plan to dramatically reduce prevention goals for the next five years. Whereas in 2000 the CDC set the goal of reducing new infections by 50 percent by 2005, the "Addendum to the CDC Prevention Strategic Plan Through 2005" released this week only seeks to reduce new infections by 10 percent by the year 2010.

"We're disappointed," says Sean Barry, director of prevention policy for Community HIV/AIDS Mobilization Project (CHAMP), who attended the meeting. "The CDC is giving up on presenting a professional, needs-based vision of what resources they need and then mapping out targets. Even Bush's global AIDS initiative PEPFAR is aiming to prevent millions of infections. In the U.S. we're not setting those ambitious targets."

It's not clear why the CDC made such a dispiriting change in its prevention goals especially since only two months ago it released its (highly criticized) plan for a "heightened response" to halting the epidemic in the African American community. The addendum claimed that the new scaled-back prevention objectives still focused "on eliminating racial and ethnic disparities in new HIV infections."

"Half of new infections are among African Americans. Even if you reduced only those infections by 10 percent, you'd still have big disparities," says David Munar, associate director of the AIDS Foundation of Chicago, adding, "This is a disappointing retreat from an achievable goal. All we have to do is appropriate and direct resources to effective programs, and we're doing neither."

More infections, fewer dollars

As troubling as the eviscerated prevention target is the likelihood of a rise in HIV infections in the U.S. According to Barry, Rob Jansen, the CDC's deputy director of HIV/AIDS Prevention, said that the U.S. will be "lucky" if there's not an increase in HIV infections in the coming years. Munar backs up that assessment. "The CDC has been doing extensive research to update its incidence estimates. It was supposed to be released last year and may be this year. But anecdotal evidence already suggests infections could be substantially higher," he says.

Under fire from meeting attendees, Jansen and Kevin Fenton, director of the CDC's National Center for HIV Prevention, explained that the CDC hadn't achieved its goal of reducing new HIV infections by 50 percent because the agency assumed it would get more prevention dollars over the years — but that never happened. The CDC's prevention budget has declined 17 percent since 2001, when the first strategic HIV-prevention plan was approved. However, the agency recently found $45 million in additional 2007 prevention funds and will be issuing grant request guidelines soon. It is expected that new dollars will be aimed at routine testing.

Fenton also said that Bush's Office of Management and Budget criticized the CDC for its goals. Barry thinks the CDC needs to see the writing on the wall: "They're still acting as if the Republicans control the Senate and Bush can interrogate any agency he wants to. It's the CDC's job to say, 'We can do more.' They've backed away from that."

Fenton, Jansen and others at the CDC did not return the Update's calls.

The CDC's budget woes are not likely to end any time soon. It's facing budget reductions for fiscal year 2008 despite the fact that director Julie Gerberding says she needs $1 billion increase in funding for the agency to do its job.
More bad timing

The CDC heightened the ire of CHAC committee members by releasing its new prevention targets on Friday afternoon, May 4, giving those on the committee little time to evaluate it before the advisory council meeting began on Monday, May 7. "I think the CDC was trying to rush a decision on this," says Barry. They're a couple years overdue in amending the plan—so it's not like they haven't had time to work on it. They knew this would stir up resentment and opposition."

Conference attendees proposed numerous revisions to the CDC plan, which also set goals for the numbers of people getting tested, the scope of prevention, care and treatment services, and the monitoring of the epidemic and success of programs aimed at stopping it.

Committee-member resistance led CDC officials to say they would "stay up late" Monday night and come back with a revised proposal. The revision compromise says the goal is to "reduce new HIV infections by a minimum of 5 percent a year" while keeping the 10 percent by 2010 objective, and "incorporate... resource strategies and constraints to further explain the achievement of past and new goals."

Barry was unimpressed by the changes and could only grasp at a future silver lining. "We're on the verge of a presidential election. I can only hope that this setback in the federal government's commitment to prevention can be used to draw a distinction between the path we're on now and the path the next president needs to take us on."