No Time to Lose: Getting More from HIV Prevention

Introduction - rethinking HIV prevention. Tracking the epidemic: national AIDS surveillance system; rationale for a national system of HIV surveillance; HIV case reporting; population-based HIV incidence estimation. Allocating resources: current allocation of federal HIV prevention funds; assessing the cost-effectiveness of HIV prevention interventions - protecting the blood supply, preventing perinatal transmission of HIV, implementing needle exchange programs; using epidemic impact as a measure of success; a strategic vision for HIV prevention investments; resource allocation for HIV prevention allocating resources at the community level, allocating resources at the national level; support for state and local resource allocation. Using the clinical setting: clinical care-based prevention; programs that provide clinical care to HIV-infected persons - financing of HIV care; changes needed to encourage HIV prevention: Medicaid and Ryan White - care act programs; financing options for Medicaid coverage; encouraging HIV prevention in CARE act programs; DHHS-wide policies to encourage integration of prevention into clinical care. Translating research into action: current efforts in prevention technology transfer; barriers to effective technology transfer at the community level; opportunities for improving prevention technology transfer. Searching for new tools: promising new tools - rapid testing methods for detecting HIV antibodies, alternative barrier methods, antiretroviral therapies, vaccines; promising new collaborations. Overcoming social barriers: social barriers - poverty, racism, and gender inequality, the sexual "code of silence", stigma of HIV/AIDS, misperceptions, lack of leadership; unrealized opportunities - access to drug treatment and sterile injection equipment, comprehensive sex education and condom availability in schools. Appendices: the changing epidemic; the prevention portfolio: intervention to prevent; HIV infection; federal spending on HIV/AIDS; description and mathematical statement of the HIV prevention; resource allocation model; data gathering activities; agendas for public committee meetings.