It’s impossible to imagine that a four-day conference where the terms “oral sex,” “anal sex” and “casual sex” were used hundreds of times per day could be as unstimulating as the Centers for Disease Control & Prevention’s annual National HIV Prevention Conference this week in Atlanta.
In fairness, no scientific conference is sexy or entertaining. But the CDC’s drowsy gathering, whose theme was “Promoting Synergy Between Science & Program,” did more to expose the disconnect that exists between the HIV-prevention industry and the people it is trying to protect.
The impromptu response to HIV/AIDS by everyday gay people early in the epidemic was more effective than the corporatized strategies of today, which are constrained by politics and scientific protocols, AIDS activist and researcher Rafael Diaz said at the conference.
“As prevention became a professional endeavor, the exhaustion [among the public], the ‘Us vs. Them’ started to happen,” said Diaz, director of the Gay Men of Color Initiative at the University of San Francisco’s Cesar Chavez Institute. “We need to put prevention back in the community.”
In an indication of CDC strategies missing the mark, the agency touted at the conference eight new “Diffusion of Effective Behavioral Interventions” — which are also known as “DEBIs,” and are the only type of program eligible for CDC funding — with not a single one of the interventions targeting the most at-risk group in America, gay and bisexual men.
The CDC also announced that only 20 percent of all gay and bisexual men come in contact with one of its DEBIs, with critics charging that systemic barriers prevent more programs geared toward gay and bisexual men from becoming available.
“And this is 26 years into the epidem
ic,” conceded Kevin Fenton, director of the CDC’s AIDS prevention programs, who is openly gay. “So we do have some way to go in penetrating our prevention interventions.”
Additionally, the federal government has responded to rising HIV rates by flat-funding the CDC throughout most of the Bush administration, decreasing the agency’s actual buying power by 19 percent — to 1993 levels — when adjusted for the depreciated dollar, said David Holtgrave, a former CDC researcher who now works at the John Hopkins Bloomberg School of Public Health.
But government problems have been a hallmark of the domestic AIDS epidemic, and many activists say it doesn’t relieve individuals and communities of their responsibilities in preventing the spread of HIV.
“The civil rights movement didn’t get funded by the federal government,” said Robert Fullilove, a researcher at Columbia University. “We have the capacity … to let people know the all clear has not sounded.”
Various “homegrown” HIV prevention programs sprouted up during the first 15 years of the epidemic, until there were so many that there was confusion among community-based organizations about which interventions worked, said CDC researcher David Purcell.
“In the beginning, there was no such thing as a DEBI,” said Purcell, who noted that the CDC first released a compendium of evidence-based interventions in 1999. There are currently 14 DEBIs, three of which are specifically designed for gay and bisexual men.
“With [the CDC announcing] eight new DEBIs coming, to not see any that are specifically for [gay and bisexual men], particularly [gay and bisexual men] of color, is really surprising, because we really need more resources for that population,” said Victor Martinez, a regional director for Bienestar, a Latino AIDS agency in Los Angeles.
Any AIDS non-profit that receives funding directly from CDC must use the dollars on DEBIs, with CDC’s mantra being “fidelity to protocol.” The CDC also funds state and local health departments, which then distribute the money to local non-profits. Health departments have more flexibility in funding “homegrown” interventions, but many maintain the CDC’s insistence on DEBIs, Purcell said.
Developing a creative, relevant and locally produced intervention into a DEBI is a complicated, years-long process that many community-based organizations lack the capacity to undertake. The DEBI threshold requires interventions to be scientifically proven via randomized control trials.
Under increasing pressure from activists and non-profit agencies who complain that the DEBIs are too limiting and not always applicable to different populations, the CDC unveiled a new funding system based on “Tiers of Effectiveness.”
Instead of exclusively funding DEBIs, the CDC will begin evaluating other interventions to see if they might contain useful strategies, even if they lack solid scientific evidence, Purcell said.
Funding priority will be given to Tier I and Tier II interventions, which are “evidence-based” and require controlled scientific studies, said CDC researcher Cynthia Lyles. Funding will also be made available for some “theory-based” interventions listed in Tiers III and IV, Lyles said.
There are currently 30 Tier I interventions, with only four designed for gay and bisexual men, and 18 Tier II programs, with zero targeting the population that accounts for nearly half of all HIV infections in the U.S.
Underfunded by the federal government for years, research into programs targeting gay and bisexual men “continues to be a big gap,” Purcell said.
Like many activists, Martinez is disillusioned by the slowness of CDC’s procedures during an age when change takes place by the second.
“Tier I and Tier II is still very difficult, and it takes a long time,” Martinez said. “By the time a new intervention has been approved, released [to other non-profit agencies], we ask for training from CDC, we get training, and it’s implemented — five, seven years have passed, and it may be outdated by then.”
CDC officials declined to discuss one of the topics creating the most buzz at the conference: the pending release of new data that reportedly shows the number of annual HIV infections is dramatically higher than the 40,000 cases the government has long reported. First reported Nov. 14 in the Washington Blade, a sister publication of Southern Voice, the actual numbers could be as high as 60,000 per year, a 50 percent increase.
“We are as eager as everyone to have this critical information and to use it to guide national prevention efforts, but it would not be responsible for us to discuss or to speculate about the estimates before they’re final and we’re certain that these estimates are reliable,” Fenton said. He added the estimates include “statistical assumptions” which are “still undergoing rigorous analysis and scientific review.”
Hundreds of people protested outside the CDC conference at a Dec. 4 rally and mar
