August 31, 2010

HIV Prevention: Pay Now, Save Later

For the first time in the history of the epidemic, our country has a comprehensive National HIV/AIDS Strategy. What’s more, researchers now claim that a short-lived, but large infusion of cash could cut the infection rate almost in half within 10 years and save hundreds of billions of dollars. Yes we’re in the middle of a terrible recession, and Congress has never been more averse to spending, but activists argue that the cost of not coming together as a community to fight for more prevention dollars is too high.

It was a rare occurrence during a scientific session at an AIDS conference: a thunderous standing ovation. The enthusiastic applause at the XVIII International AIDS Conference in Vienna was in response to a presentation in which researchers determined that a microbicidal gel made with the antiretroviral drug tenofovir unambiguously cut HIV transmission by nearly 40 percent in a study of South African women.

It was a eureka moment. However, it was only the first of several studies expected over the next few years that will be needed to conclude whether microbicides made with common HIV drugs are both safe and effective as biomedical prevention approaches.

Results from a second study of tenofovir (found in the approved drugs Viread, Truvada and Atripla), either in a microbicidal gel or pill form, aren’t expected until sometime in 2013 and approval from the U.S. Food and Drug Administration (FDA) would only come many months later. Even then, it’s not clear how the gel will be recommended or paid for, and there’s another catch: The gel will only be approved for vaginal sex (rectal microbicide research is still in its infancy).

Three to five years is a long time to wait for a product that works for vaginal sex, but might not be safe or effective for two of the most common forms of HIV transmission in the United States: anal sex—the primary route of transmission in men who have sex with men (MSM)—and sharing syringes when injecting drugs.

Public health experts have another solution, though: Do a lot more of what we’re already doing.

According to HIV prevention specialists and researchers from the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta and Johns Hopkins University in Baltimore, simply ramping up current efforts by a wide margin could cut new infections by nearly half. Moreover, their study—which was published online July 14 in the Journal of Acquired Immune Deficiency Syndromes (JAIDS)—asserts that a substantial, but short-term, investment in prevention could avert hundreds of thousands of HIV infections and save the U.S. taxpayer hundreds of billions of dollars in future health care costs.

“From a technical and epidemiologic point of view, [the study is] well done and as solid a set of calculations as could be made,” says Walt Senterfitt, PhD, RN, MPH, an epidemiologist and the cochair of the board of directors of the Community HIV/AIDS Mobilization Project (CHAMP).

The CDC and the Obama administration are earning praise from some unexpected quarters for publishing these estimates, which, along with the July release of the National HIV/AIDS Strategy (NHAS), demonstrate a new willingness to heed community recommendations and to give the community the tools it needs to argue persuasively for more resources. The NHAS demands that prevention resources be targeted where the need is greatest—among MSM and black women—and calls for an exploration for how social circumstances such as poverty, stigma and incarceration exacerbate disparities in health by race, sexual and gender orientation and economics. What’s more the NHAS calls for a 25 percent reduction in new infections by 2015, and the new study says we can do even better.

While the published projections make a strong economic and scientific case for increasing HIV prevention funding, they don’t necessarily make it any easier to ask Congress—and the American people—to invest $1 billion more into HIV prevention programs each year for the next 5 to 10 years, particularly with the risk of a double-dip economic recession looming. “That’s a hard sell, a very hard sell,” says David Munar, vice president of the AIDS Foundation of Chicago.

If there’s any hope of influencing the general public and Congress, the community might need to devote as much time and energy to the fight for increased prevention funding as it did recently to save the state AIDS Drug Assistance Programs (ADAPs), suggests Laura Hanen, the director of government relations for the National Association of State and Territorial AIDS Directors (NASTAD).

“The American taxpayer needs to be convinced that this is worth spending additional taxpayer dollars,” Hanen says. “We have to figure out a way to prioritize prevention. You can see it on the global side. You can’t treat your way out of this epidemic. With only 4 percent of our funding in HIV focused on prevention, it’s just not acceptable…or winnable.”

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Frederick Wright, Tampa, 2010-09-07 10:03:17
Spending more federal money is going to be hard to find at this time for the money is not their, for schools need funds, Hspital needs funds and working families need jobs. The solution is not in more money from the Feds where a lot of hands are in the pot. The solution is in the community to fund condoms and less conferences and less staff that sucks the money from Costly Universities, and Non Profits, How about the Excutive Directors of AIDS INC giving back a few bucks to a condom fund.