Index

A

Abstinence education programs, components of, 119n

“Abstinence-plus” programs, 117

Access

to drug abuse treatment, 106-116

to sterile drug injection equipment, 114-116

ACHSP. See Advisory Committee for HIV and STD Prevention

Acquired immunodeficiency syndrome. See AIDS

ACSUS. See AIDS Cost and Services Utilization Survey

ADAMHA Reorganization Act of 1992, 167

ADAP. See AIDS Drug Assistance Program

Adolescent AIDS cases, by exposure category, 141

Adolescent Family Life Act (AFLA), 118-119

Adolescent sex workers, 189

Adult AIDS cases, by exposure category, 141

Adult correctional systems, HIV/AIDS education, harm reduction, and discharge planning programs in U.S., 122

Advisory Committee for HIV and STD Prevention (ACHSP), 74

AFLA. See Adolescent Family Life Act

Africa, HIV incidence in, 105, 140

African Americans

Medicaid services provided to, 57

rates of AIDS infection among, 143-145

Agency for Health Care Quality and Research, spending on HIV/AIDS, 172

Aggregate HIV incidence, estimating, 173

AIDS cases

adult/adolescent, by exposure category, 141

and co-occurring conditions, 147-148, 152

geographic distribution of, 145-146

inadequacy of reporting based on, 15

increases in, 1

lag in diagnosis time for, 4, 81n

perinatally acquired, 144-145

providers caring for, 55-56

“public health” responses to, 22

in racial and ethnic minorities, 144-145

rates per 100,000 population, 146

and sexual orientation, 2

in women, 142-143

in youth, 143-144



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No Time to Lose: Getting More from HIV Prevention Index A Abstinence education programs, components of, 119n “Abstinence-plus” programs, 117 Access to drug abuse treatment, 106-116 to sterile drug injection equipment, 114-116 ACHSP. See Advisory Committee for HIV and STD Prevention Acquired immunodeficiency syndrome. See AIDS ACSUS. See AIDS Cost and Services Utilization Survey ADAMHA Reorganization Act of 1992, 167 ADAP. See AIDS Drug Assistance Program Adolescent AIDS cases, by exposure category, 141 Adolescent Family Life Act (AFLA), 118-119 Adolescent sex workers, 189 Adult AIDS cases, by exposure category, 141 Adult correctional systems, HIV/AIDS education, harm reduction, and discharge planning programs in U.S., 122 Advisory Committee for HIV and STD Prevention (ACHSP), 74 AFLA. See Adolescent Family Life Act Africa, HIV incidence in, 105, 140 African Americans Medicaid services provided to, 57 rates of AIDS infection among, 143-145 Agency for Health Care Quality and Research, spending on HIV/AIDS, 172 Aggregate HIV incidence, estimating, 173 AIDS cases adult/adolescent, by exposure category, 141 and co-occurring conditions, 147-148, 152 geographic distribution of, 145-146 inadequacy of reporting based on, 15 increases in, 1 lag in diagnosis time for, 4, 81n perinatally acquired, 144-145 providers caring for, 55-56 “public health” responses to, 22 in racial and ethnic minorities, 144-145 rates per 100,000 population, 146 and sexual orientation, 2 in women, 142-143 in youth, 143-144

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No Time to Lose: Getting More from HIV Prevention AIDS Cost and Services Utilization Survey (ACSUS), 56 AIDS Drug Assistance Program (ADAP), 169 AIDS Education Training Centers, established under the Ryan White CARE Act of 1990, 170 AIDS incidence versus allocation of HIV prevention funds, 32 CDC-allocation of HIV prevention funds versus, 32 estimates of, 141 by state, 32 AIDS pandemic global, 140 projecting, 15 AIDS Research Program Evaluation Working Group, 76-77 AIDS service organizations (ASOs), 68 improving organizational capacity of, 72-73 Alaskan Natives, HIV prevention programs for, 171 Alcohol use, 107n Alliance for Microbicide Development, 85-86, 90 Alliances, for health departments, 193 Allocating resources for HIV prevention, 5-6, 26-49. See also HIV prevention investments versus AIDS incidence by state, 32 assessing the cost-effectiveness of, 32-35 calculations for, 175-177 at the community level, 39 current allocation of federal, 28-32 at the national level, 39-46 optimizing, 44-46 state and local, 3, 46-47 a strategic vision for, 37 using epidemic impact as a measure of success, 35-37 Alternative barrier methods, 83-86 the female condom, 83-84 microbicides, 84-86 “America Responds to AIDS” (ARTA), 158 American Academy of Pediatrics, 118 American Foundation for AIDS Research, 90 American Indians, HIV prevention programs for, 171 American Journal of Public Health, 173 Anal intercourse, male condom use during, 36 Annual infections prevented cost-effectiveness versus proportional allocation, 43 impact of investing in better, more expensive programs, 45 percentage improvement, 44 Antimicrobial therapies, advances in, 7 Antiretroviral therapies, 86-87 advances in, 2, 7, 14 HIV-infected persons receiving, 51 nevirapine, 34, 156 optimizing patient adherence to, 53-54 Public Health Service Task Force recommendations for use of, 34 zidovudine, 34, 142, 156 ARTA. See “America Responds to AIDS” ASOs. See AIDS service organizations Assessing the cost-effectiveness of HIV prevention interventions, in allocating resources, 32-35 At-risk populations, 2, 12, 99-100 B “Back calculations,” 148 Balanced Budget Act of 1997, 119 Barrier methods, alternative, 83-86 Barrier products, 171 Barriers to HIV care, 98-128 access to drug abuse treatment, 106-116 access to sterile drug injection equipment, 114-116 comprehensive sex education and condom availability in schools, 116-120 HIV prevention in correctional settings, 120-128 lack of leadership, 104-105 misperceptions, 103-104 poverty, racism, and gender inequality, 98-100 requests for public comment on, 189-190 the sexual “code of silence,” 100-101 stigma of HIV/AIDS, 101-103

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No Time to Lose: Getting More from HIV Prevention Base scenario, at the national level of resource allocation, 42 Baseline rate of new infections, 33 Behavioral interventions to prevent HIV infection, 155-156 new infections, 153-155 Behavioral surveillance, 17 Bill and Melinda Gates Foundation, 90 Biomedical interventions, to prevent HIV infection, 156-157 Biomedical strategies, used in preventing new HIV infections, 153-155 Bleach, used for HIV disinfection, 125 Blood samples, procedures for taking, 20 Blood supply in assessing the cost-effectiveness of HIV prevention interventions, 33-34 protecting, 33-34 Buprenorphine, 110 C Capitation payments, 60 CAPS. See Center for AIDS Prevention Studies model CARE Act. See Ryan White Comprehensive AIDS Resources Emergency Act of 1990 Case finding approach, 16-19 alternative to surveillance, 16 Case reporting, in tracking the HIV epidemic, 16-19 CBOs. See Community-based organizations CDC. See Centers for Disease Control and Prevention CDC Behavioral and Social Science Volunteer Project, 69, 72 Center for AIDS Prevention Studies, 193 Center for AIDS Prevention Studies (CAPS) model, 75-76 Center for Mental Health Services (CMHS), 167 Center for Substance Abuse Prevention (CSAP), 167 Center for Substance Abuse Treatment (CSAT), 167 Centers for AIDS Research (CFARs), 76 Centers for Disease Control and Prevention (CDC), 2, 11, 34 allocation of HIV prevention funds versus AIDS incidence by state, 32 intervention/program implementation, 164-165 leading role played in HIV prevention, 26, 47 policy, 165 position on HIV testing, 55 program evaluation, 165 publicly funded sites of, 55n recommendations to, 59 research under, 68, 165 spending on HIV/AIDS, 164-165 studies by, 52-53 surveillance by, 15, 165 syphilis elimination plan, 62 technical assistance, 165, 186 Changes in Medicaid and Ryan White Care Act programs needed to encourage HIV prevention, 58-63 Changes in the epidemic, 139-151 AIDS trends in the United States, 139-148 demographics of, 142-146 HIV incidence and prevalence, 148-149 Changes needed to encourage HIV prevention, 58-63 encouraging HIV prevention in CARE Act programs, 61-63 financing options for Medicaid coverage, 58-61 Characteristics of Reputationally Strong Programs Project, 69 Children health care settings utilized by, 56 programs for under the Ryan White CARE Act of 1990, 170 Clinical care for HIV-infected persons financing, 56-58 programs that provide, 55-58 Clinical settings, 50-67 changes in Medicaid and Ryan White Care Act programs needed to encourage HIV prevention, 58-63 DHHS-wide policies to encourage integration of prevention into clinical care, 63 programs that provide clinical care to HIV-infected persons, 55-58 using for prevention, 6, 51-55

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No Time to Lose: Getting More from HIV Prevention Clinton Administration, 29 CMHS. See Center for Mental Health Services Co-occurring conditions, 152 trends in the United States, 98, 147-148 Cocaine use, 107n “Code of silence,” as a social barrier, 100-101 Commission on Health Research for Development, 90 Community and Migrant Health Center (CHCs) program, 57-58 Community-based organizations (CBOs), 68, 193 improving organizational capacity of, 72-73 Community Health Centers (CHCs) HIV tests performed at, 55n programs of, 57 Community-level resource allocation for HIV prevention, 39 Community Planning Groups (CPGs), 28, 29, 165, 191 Community Planning Leadership Summit, 180-185 Compendium of HIV Prevention Interventions with Evidence of Effectiveness, 69, 70, 152 Comprehensive sex education, in schools, 116-120 Condom availability, 157 in correctional facilities, 125-126 in schools, 116-120 Condom use female, 83-84 male, 36 Confidentiality issues, 18-19. See also Reporting issues in testing, 29 Connecticut, drug paraphernalia laws in, 115 Consensus Panel on Interventions to Prevent HIV Risk Behaviors, 119 Consortium for Industrial Collaboration in Contraceptive Research, 90 Coordination of programs lack of, 3, 188 requests for public comment on, 188-189 Correctional systems condom availability in, 125-126 HIV/AIDS education, harm reduction, and discharge planning programs in U.S. adult, 122 HIV prevention in, 120-128 needle exchange programs in, 126 Cost-effectiveness of HIV prevention interventions, 32-35, 107n assessing in the allocation of resources, 32-35 implementing needle exchange programs, 34-35 preventing perinatal transmission of HIV, 34 versus proportional allocation in preventing annual infections, 43 protecting the blood supply, 33-34 Costs of HIV interventions, 40-42, 174-175 Costs of HIV testing, 83 Costs of HIV treatment, 42 Counseling, 106 by race and ethnicity, 30 CPGs. See Community Planning Groups CSAP. See Center for Substance Abuse Prevention CSAT. See Center for Substance Abuse Treatment Current allocation of federal HIV prevention funds, in allocating resources, 28-32 Current national AIDS surveillance system, 15 D Data gathering activities, 180-193 Community Planning Leadership Summit, 180-185 problems with expanding, 186 requests for public comment, 185-190 site visits to state health departments, 190-193 Data needs, requests for public comment on, 185-186 Deaths, estimates of, 141 Demographics of the AIDS epidemic, 14, 142-146 cases in racial and ethnic minorities, 144-145 cases in women, 142-143

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No Time to Lose: Getting More from HIV Prevention cases in youth, 143-144 geographic distribution, 145-146 Dental Reimbursement Program, established under the Ryan White CARE Act of 1990, 170 Department of Defense Health Care Systems, 56 Department of Health and Human Services (DHHS) Agency for Health Care Quality and Research, 172 categorization of those needing treatment, 108 Centers for Disease Control and Prevention, 28, 164-165, 186 Food and Drug Administration, 170-171 Health Care Financing Administration, 171 Health Resources and Services Administration, 168-170, 182, 186 Indian Health Service, 171 National Institutes of Health, 28, 165-167, 182 need for strong leadership from, 4 policies to encourage integration of prevention into clinical care, 63 regulatory role of, 111 spending on HIV/AIDS, 28, 164-172, 182 Substance Abuse and Mental Health Administration, 28, 167-168 Department of Justice, 56 Department of Veterans Affairs Health Care System (VA), 56 Description and mathematical statement of the HIV prevention resource allocation model, 173-179 allocating resources for HIV prevention, 175-177 the costs of HIV prevention programs, 174-175 estimating aggregate HIV incidence, 173 estimating the efficacy and reach of HIV prevention programs, 174 Detecting HIV antibodies, rapid testing methods for, 80-83 DHHS. See Department of Health and Human Services Diabetes, 190 Diagnosis time for AIDS cases, lag in, 4, 81n Discharge planning in correctional settings, 121-123 for U.S. adults, 122 Disease progression, advances in antiretroviral therapies to prevent, 2, 7, 14 Disinfection, use of bleach for, 125 Domestic federal HIV/AIDS spending, fiscal year 1995-1999, 163 Drug abuse, link to spread of AIDS, 106 Drug abuse treatment access to, 106-116 in correctional settings, 124-125 Drug control spending, federal, 111 Drug Enforcement Agency, regulatory role of, 111 Drug injection equipment, access to sterile, 114-116 Drug paraphernalia laws, in Connecticut, 115 Drug-resistant HIV, re-infection with, 52 E Early and Periodic Screening, Diagnostic, and Treatment program, 58 Early intervention grants, under the Ryan White CARE Act of 1990, 170 Education components of abstinence programs, 119n in U.S. adult correctional systems, 122 Efficacy of HIV interventions, 40, 174-175 measured in quality adjusted life years, 38n EIA test. See Enzyme-linked immunoassay test Eligible Metropolitan Areas (EMAs), 169 Enzyme-linked immunoassay (EIA) test, 33, 81 Epidemic impact, allocation of resources as a measure of success, 35-37 Estimates of aggregate HIV incidence, 173 of AIDS incidence, deaths, and prevalence in adults, 141 of efficacy and reach of HIV prevention programs, 174 Ethnic minorities, AIDS cases in, 144-145

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No Time to Lose: Getting More from HIV Prevention Ethnicity counseling, testing, referral, and partner notification by, 30 health education and risk reduction by, 30-31 proportion of AIDS cases by, 145 Evaluations of Centers for Disease Control and Prevention programs, 165 of HIV prevention programs for workability, 192 Expenditures for HIV prevention. See Allocating resources for HIV prevention Expensive programs, impact on preventing annual infections of investing in, 45 Exposure categories, 140-141 adult/adolescent AIDS cases by, 141 F FDA. See Food and Drug Administration Federal Bureau of Justice, studies by, 124 Federal drug control spending, 111 Federal HIV prevention funds, current allocation of, 28-32 Federal Regulation of Methadone, 111n Federal spending on HIV/AIDS, 162-172 additional technical assistance needed in HIV prevention activities, 192 Agency for Health Care Quality and Research, 172 Centers for Disease Control and Prevention, 164-165 Department of Health and Human Services, 164-172 for fiscal year 1995-1999, domestic, 163 Food and Drug Administration, 170-171 Health Care Financing Administration, 171 Health Resources and Services Administration, 168-170 Indian Health Service, 171 National Institutes of Health, 165-167 overview of, 162-164 Substance Abuse and Mental Health Administration, 167-168 Fee-for-service, Medicaid coverage for, 59-60 Female condom use, 83-84 Financing options for Medicaid coverage, 58-61 Medicaid fee-for-service, 59-60 Medicaid managed care organizations, 60-61 Food and Drug Administration (FDA) recommendations concerning tests, 34, 81-82 regulatory role of, 110-111, 170 spending on HIV/AIDS, 170-171 Funding HIV prevention. See Allocating resources for HIV prevention G GAO. See U.S. General Accounting Office Gates Foundation, 90 Gender inequality, as a social barrier, 98-100 Geographic distribution, of AIDS cases, 145-146 Global HIV/AIDS pandemic, 140 Grants. under the Ryan White CARE Act of 1990, 169-170 under the Substance Abuse and Mental Health Administration, 167-168 H Hampden County Correctional Center (in Massachusetts), HIV prevention in, 123 Harm reduction programs, in correctional settings, 122, 125-128 HCFA. See Health Care Financing Administration HCSUS. See HIV Cost and Services Utilization Study Health Care Financing Administration (HCFA), 57, 171 Medicaid services under, 59, 171 Medicare services under, 171 recommendations to, 59 spending on HIV/AIDS, 59n, 171

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No Time to Lose: Getting More from HIV Prevention Health departments, potential new partnerships or alliances for, 193 Health education, by race and ethnicity, 31 Health professionals’ training, integrating HIV prevention early in, 54 Health Resources and Services Administration (HRSA), 28, 77, 168-170, 182 Ryan White Comprehensive AIDS Resources Emergency Act of 1990, 168-170 spending on HIV/AIDS, 168-170, 186 studies by, 52-53 Heart disease, 190 Hewlett Foundation, 90 The Hidden Epidemic, recommendations from, 101 Hierarchical surveillance, 141n Hispanics Medicaid services provided to, 57 rates of AIDS infection among, 143-145 HIV/AIDS High Risk Behavior Prevention/ Intervention Model for Youth Adult/Adolescent and Women Program, 168 HIV antibodies, rapid testing methods for detecting, 80-83 HIV case reporting, in tracking the epidemic, 16-19 HIV Cost and Services Utilization Study (HCSUS), 56 HIV Cost Study, 168 HIV disinfection, use of bleach for, 125 HIV education, harm reduction, and discharge planning programs, in U.S. adult correctional systems, 122 HIV incidence estimation changes in, 148-149 population-based, in tracking the epidemic, 19-23 HIV-infected persons categorization of by DHHS, 108 complacency among, 1 extending prevention efforts to, 50 programs that provide clinical care to, 55-58 receiving antiretroviral therapy, 51 HIV infections, allocating resources for prevention of new, 5-6, 11 HIV interventions, cost, reach, and efficacy of, 40 HIV outreach grants, under the Substance Abuse and Mental Health Administration, 168 HIV pandemic, global, 140 HIV prevalence, changes in, 148-149 HIV prevention changes needed to encourage, 58-63 defining, 27n encouraging in CARE Act programs, 61-63 estimating the efficacy and reach of, 174 integrating early in health professionals’ training, 54 leading role played by the Centers for Disease Control and Prevention in, 26 programs for Native Americans, 171 resource allocation for, 38-46 rethinking, 11-13 unrealized opportunities for improving, 193 HIV Prevention Community Planning Process, 76 HIV Prevention Evaluation initiative, 75n HIV prevention funds, CDC allocation of, versus AIDS incidence by state, 32 HIV prevention in correctional settings, 120-128 discharge planning, 121, 123 drug abuse treatment, 124-125 harm reduction programs, 125-128 HIV prevention education, 123 HIV Prevention Initiative for Youth and Women of Color, 168 HIV prevention investments, 33 development of new tools and technologies for, 7-8 strategic vision in allocating resources, 26, 37 HIV prevention research dissemination, examples of, 70-71 HIV Prevention Science Initiative, 166 HIV prevention strategies description and mathematical statement of resource allocation model for, 173-179 examples of research dissemination, 70-71

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No Time to Lose: Getting More from HIV Prevention prioritizing and selecting for implementation, 191 HIV risk assessments, guides for conducting, 54 HIV status emphasis on people learning, 81 outreach to those of unknown, 61 HIV surveillance approaches, comparison of, 22 Homicide, 190 HRSA. See Health Resources and Services Administration Human immunodeficiency virus. See HIV I IDUs. See Injection drug users Immunofluorescence assay, 81n Impact of investing in better, more expensive programs, on preventing annual infections, 45 Implementation of Centers for Disease Control and Prevention programs, 164-165 of HIV prevention programs, 192-193 of needle exchange programs, 34-35 removing obstacles to, 13 requests for public comment on, 188-189 Improving HIV prevention, unrealized opportunities for, 193 Incidence estimation, 141 changes in HIV, 4, 148-149 declines in, 14 population-based, in tracking the HIV epidemic, 19-23 Indian Health Service, spending on HIV/ AIDS, 171 Infants, programs for under the Ryan White CARE Act of 1990, 170 Infected persons complacency among, 1 extending prevention efforts to, 50-51 programs that provide clinical care to, 55-58 Infections. See HIV infections; New HIV infections; Re-infection Injection drug users (IDUs), 34. See also Sterile drug injection equipment programs targeting, 46n, 102, 189 providers caring for, 51 Institute of Medicine (IOM), 2, 111-112 defining drug addiction, 112-113n International AIDS Vaccine Initiative, 90 “Interventions in a box,” 73 Interventions to prevent HIV infection, 152-161. See also Early intervention grants behavioral interventions, 155-156 biomedical and technological interventions, 156-157 in Centers for Disease Control and Prevention programs, 164-165 interventions associated with the treatment of co-occurring conditions, 156 societal interventions, 157-158 used in preventing new HIV infections, 153-155 Investment-based approach. See HIV prevention investments K Knowledge Development and Application (KDA) programs, under the Substance Abuse and Mental Health Administration, 168 L LAAM. See Levo-alpha-acetylmethadol (LAAM) Leadership, 185 lack of as a social barrier, 3-4, 104-105 Levo-alpha-acetylmethadol (LAAM), 110n Lifesaving Vaccine Technology Act of 1999, 91 Local resource allocation, support for, 46-47 M Mail Order Drug Paraphernalia Act, 115 Male condom use, 36 Managed care organizations (MCOs), Medicaid coverage for, 59-61 Maryland, coded system of HIV case reporting, 19 Massachusetts, coded system of HIV case reporting, 19

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No Time to Lose: Getting More from HIV Prevention Massachusetts correctional system, HIV prevention in, 123 Mathematical statement, of the HIV prevention resource allocation model, 41, 173-179 Measurement techniques, changes in, 20 Medicaid services Early and Periodic Screening, Diagnostic, and Treatment program, 58 fee-for-service, 59-60 financing options for coverage, 58-61 managed care organizations, 59-61 provided to African Americans and Hispanics, 57 provided under the Health Care Financing Administration, 171 Medical Research Council, 89 Medicare services, provided under the Health Care Financing Administration, 171 Men who have sex with men (MSM), 140, 183 Mental illness, link to spread of AIDS, 147, 152 Methadone, regulation of, 110-111 Metropolitan areas, grants to under the Ryan White CARE Act of 1990, 169 Microbicides, 84-86 advances in, 7 workings of, 84-85 Military health care options. See Department of Defense Health Care Systems Misperceptions, as a social barrier, 103-104 Modeling, statistical, 19 Modes of transmission. See Transmission Monitoring HIV prevention programs, additional information needed for, 192 Moriah Fund, 90 MSM. See Men who have sex with men N N-9. See Nonoxynol-9 Naltrexone, 110 NAT test. See Nucleic Acid Amplification Technology test National AIDS Control Programme (in Uganda), 105 National AIDS surveillance system, in tracking the epidemic, 15 National Cancer Institute, 165, 167 National Center for Research Resources, 165 National Health Interview Survey, 20 National Heart, Lung and Blood Institute, 165 National Institute for Drug Abuse, 165 National Institute of Allergy and Infectious Diseases, 165, 167 National Institute of Child Health and Human Development, 165 National Institute of Justice, studies by, 125 National Institute of Mental Health (NIMH), 75, 165 National Institutes of Health (NIH), 28, 165-167, 182 Consensus Panel on Interventions to Prevent HIV Risk Behaviors, 119, 152 nonvaccine prevention research under, 166-167 spending on HIV/AIDS, 165-167 vaccine research under, 68, 167 National level resource allocation for HIV prevention, 39-46 base scenario, 42 optimistic scenario, 42 pessimistic scenario, 42 National Research Council (NRC), 20, 34 Native Americans, HIV prevention programs for, 171 Needle exchange programs in assessing the cost-effectiveness of HIV prevention interventions, 34-35 in correctional facilities, 126 implementing, 34-35 programs targeting, 46 Nevirapine, 34, 156 New HIV infections baseline rate of, 33 developing an accurate surveillance system for, 4-5 populations growing in, 2 NIH. See National Institutes of Health NIMH. See National Institute of Mental Health Nonoxynol-9 (N-9), 85

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No Time to Lose: Getting More from HIV Prevention Nonvaccine prevention research, under the National Institutes of Health, 166-167 Nucleic Acid Amplification Technology (NAT) test, 34 O OAR. See Office of AIDS Research Office of AIDS Research Advisory Council, AIDS Research Program Evaluation Working Group, 76-77 Office of AIDS Research (OAR), 165 Office of National Drug Control Policy, 107 Opportunistic infections, tuberculosis, 52 Opportunities requests for public comment on, 189-190 unrealized, for overcoming social barriers, 106-128 Optimistic scenario, at the national level of resource allocation, 42 Outreach to those of unknown HIV status, CARE Act Title III support for, 61 Overcoming social barriers, 97-135 social barriers described, 98-105 unrealized opportunities for, 106-128 P PACHA. See Presidential Advisory Council on HIV/AIDS Partner notification, by race and ethnicity, 30 “Partnership for Health” studies, 53 Partnerships for health departments, 75, 193 Patients. See HIV-infected persons “Payer of last resort,” CARE Act programs as, 57, 169 Pediatric HIV surveillance, 18 Percentage improvement, in preventing annual infections, 44 Perinatal transmission in acquired AIDS cases, 141-142 assessing the cost-effectiveness of HIV prevention interventions, 34 preventing, 7 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), 119 Pessimistic scenario, at the national level of resource allocation, 42 “Physician Delivered Intervention for HIV+ Individuals,” 53 Planning effective HIV prevention programs additional information needed for, 192 barriers encountered, 193 Policy issues in Centers for Disease Control and Prevention programs, 165 explicit goals of, 11-12 Population-based HIV incidence estimation, in tracking the epidemic, 19-23 Poverty, as a social barrier, 98-100 Presidential Advisory Council on HIV/ AIDS (PACHA), 69, 74 Prevalence in adults, estimates of, 141 changes in HIV, 148-149 Prevention, 6, 51-55 effectiveness of, 11 “missing link” in, 187 of new HIV infections, 5-6, 153-155 of perinatal transmission of HIV, 34 Prevention budgets, 38-39 Prevention education, in correctional settings, 123 Prevention Marketing Initiative, 158 Prevention portfolio, 152-161 behavioral interventions, 155-156 biomedical and technological interventions, 156-157 interventions associated with the treatment of co-occurring conditions, 156 societal interventions, 157-158 Prevention research, requests for public comment on translating into practice, 187 Prevention Research Synthesis (PRS) project, 69 Prevention Science Working Group, 166 Prevention technology transfer current efforts in, 68-72 opportunities for improving, 74-77 Prioritizing, HIV prevention strategies for implementation, 191 Privacy issues, 18-19

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No Time to Lose: Getting More from HIV Prevention Program evaluation, requests for public comment on, 187-188 Proportion of AIDS cases, by race and ethnicity, 145 Proportionality in allocation, versus cost-effectiveness, 5, 31-32 in preventing annual infections, 43 Protecting the blood supply, 33-34 Providers caring for AIDS cases, 56 caring for injection drug users (IDUs), 51 PRWORA. See Personal Responsibility and Work Opportunity Reconciliation Act Psychotherapy, 106 Public comment, requests for, 185-190 “Public health” responses to AIDS, 22 Public Health Service Act, Title XX, 119 Public Health Service Task Force, recommendations for use of antiretroviral drugs, 34 Publicly funded sites, of the Centers for Disease Control and Prevention, 55n Q Quality adjusted life years (QALYs), measure of effectiveness, 38n R Race counseling, testing, referral, and partner notification by, 30 health education and risk reduction by, 30-31 proportion of AIDS cases by, 145 Racial minorities, AIDS cases in, 144-145 Racism, as a social barrier, 98-100 Rapid testing methods, for detecting HIV antibodies, 80-83 Rates of AIDS cases, per 100,000 population, 146 Rationale for a national system of HIV surveillance, in tracking the epidemic, 16 Re-infection, with drug-resistant HIV, 52 Reach of HIV intervention programs, 40, 174-175 Receptive anal intercourse, male condom use during, 36 Recommendations for allocating prevention resources, 5-6, 37 for a CDC-created, population-based surveillance system, 4-5 to the Centers for Disease Control and Prevention, 59 for collaboration among federal agencies, 114 for congressional policy making, 120 for creating a surveillance system, 17-18, 22 general, 191-193 to the Health Care Financing Administration, 59 from The Hidden Epidemic, 101 for HIV prevention in correctional facilities, 126-127 for investing in local-level research and interventions, 6-7, 77 for investing in products and technologies linked to HIV prevention, 7-8, 91 for legalizing injection equipment, 116 for overcoming social barriers to HIV prevention, 8 for providing prevention services as standard for all HIV-infected persons, 6, 63 of Public Health Service Task Force for use of antiretroviral drugs, 34 Referrals, by race and ethnicity, 30 1990 Report of the Commission on Health Research for Development, 90 Reporting issues, 148 Requests for public comment, 185-190 on coordination and implementation of programs, 188-189 on data needs, 185-186 on opportunities and barriers, 189-190 on program evaluation, 187-188 on technical assistance, 186 on translation of prevention research into practice, 187 Research barriers to effective technology transfer at the community level, 72-74

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No Time to Lose: Getting More from HIV Prevention in Centers for Disease Control and Prevention programs, 165 current efforts in prevention technology transfer, 68-72 under the National Institutes of Health, 166-167 opportunities for improving prevention technology transfer, 74-77 translating into action, 6-7, 68-79 Research dissemination, examples of HIV prevention, 70-71 Resource allocation for HIV prevention, 38-46. See also Allocating resources for HIV prevention Risk assessments, guides for conducting, 54 Risk reduction, by race and ethnicity, 31 Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990, 29, 57, 168-170 AIDS Education Training Centers, 170 Dental Reimbursement Program, 170 early intervention grants, 170 encouraging HIV prevention in programs of, 61-63 grants to eligible metropolitan areas, 169 grants to states and territories, 169 as “payer of last resort,” 57, 169 Special Projects of National Significance, 123, 170 Title III support for outreach to those of unknown HIV status, 61 women, infants, children, and youth, 170 S SAMHSA. See Substance Abuse and Mental Health Administration SAPT. See Substance Abuse Prevention and Treatment block grants Scenarios, at the national level of resource allocation, 42 Schools, comprehensive sex education and condom availability in, 116-120 Secondary infections, 52 Senegal, HIV incidence in, 105 Sentinel surveillance, 19-22 Serosurveys, 20 Sexual “code of silence,” as a social barrier, 100-101 Sexually transmitted diseases (STDs). See AIDS; HIV Shalala, DHHS Secretary Donna E., 115 Single Use Diagnostic System (SUDS) test, 81-82 Site visits to state health departments, 190-193 additional information needed for planning, implementing, or monitoring HIV prevention programs, 192 additional technical assistance needed from the federal government to support HIV prevention activities, 192 barriers encountered to planning or implementing effective HIV prevention programs, 193 evaluating HIV prevention programs for workability, 192 potential new partnerships or alliances health departments should pursue, 193 prioritizing and selecting HIV prevention strategies for implementation, 191 unrealized opportunities for improving HIV prevention, 193 Social barriers, 3, 12, 98-128 access to drug abuse treatment, 106-116 access to sterile drug injection equipment, 114-116 comprehensive sex education and condom availability in schools, 116-120 HIV prevention in correctional settings, 120-128 lack of leadership, 104-105 misperceptions, 103-104 poverty, racism, and gender inequality, 98-100 the sexual “code of silence,” 100-101 stigma of HIV/AIDS, 101-103 Social Security Disability Insurance (SSDI), 109 Societal interventions, to prevent HIV infection, 157-158 Special Projects of National Significance, established under the Ryan White CARE Act of 1990, 123, 170 Spermicides, 85

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No Time to Lose: Getting More from HIV Prevention SSDI. See Social Security Disability Insurance SSI. See Supplemental Security Income Standard Metropolitan Statistical Areas, 41, 173 State health departments, 58-59, 190-193 additional information needed by for planning, implementing, or monitoring HIV prevention programs, 192 additional technical assistance needed by from the federal government to support HIV prevention activities, 192 barriers encountered by to planning or implementing effective HIV prevention programs, 193 evaluations of HIV prevention programs for workability by, 192 potential new partnerships or alliances for, 193 prioritizing and selecting HIV prevention strategies for implementation by, 191 unrealized opportunities for improving HIV prevention by, 193 State resource allocation, support for, 46-47 States and territories, grants to under the Ryan White CARE Act of 1990, 169 “The States of the HIV/AIDS Epidemic,” 139n Statewide Community HIV Evaluation Project, 75n Statistical modeling, 19 STDs. See AIDS; HIV Sterile drug injection equipment access to, 114-116 policy recommendations concerning, 13 Stigma of HIV/AIDS, as a social barrier, 3, 97, 101-103 Strategic vision for HIV prevention investments in allocating resources, 37 elements of, 4 Stroke, 190 Substance Abuse and Mental Health Administration (SAMHSA), 28, 77, 108n, 167-168 Knowledge Development and Application programs under, 168 SAPT block grant-funded early intervention services (HIV set-asides) under, 167-168 SAPT block grants under, 167 spending on HIV/AIDS, 167-168 studies by, 110 Targeted Capacity Expansion and HIV outreach grants under, 168 Substance Abuse Prevention and Treatment (SAPT) block grants, 28, 58 funding of early intervention services (HIV set-asides), 167-168 under the Substance Abuse and Mental Health Administration, 167 SUDS. See Single Use Diagnostic System test Supplemental Security Income (SSI), 109 Support for HIV prevention. See Allocating resources for HIV prevention; HIV prevention investments Surveillance approaches alternative to case finding, 16 behavioral, 17 in Centers for Disease Control and Prevention programs, 165 comparison of HIV, 22 developing an accurate, for new HIV infections, 4-5 hierarchical, 141n sentinel, 19 in tracking the national AIDS epidemic, 14-15 Survey of Childbearing Women, 20, 29 Syphilis elimination plan, 62 T Targeted Capacity Expansion (TCE), under the Substance Abuse and Mental Health Administration, 168 Technical assistance in Centers for Disease Control and Prevention programs, 165, 186 requests for public comment on, 186 Technological interventions, to prevent HIV infection, 156-157 Technologies, for developing HIV prevention investments, 7-8 Technology transfer barriers at the community level to effective, 72-74

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No Time to Lose: Getting More from HIV Prevention current efforts in prevention, 68-72 opportunities for improving prevention, 74-77 Territories. See States and territories Testing confidential, 22-23 by race and ethnicity, 30 Therapies, antiretroviral, 86-87 Time lapse, in diagnosis time for AIDS cases, 4, 81n Tools, 80-89 alternative barrier methods, 83-86 antiretroviral therapies, 86-87 for developing HIV prevention investments, 7-8 promising new collaborations for, 89-91 promising new tools, 80-89 rapid testing methods for detecting HIV antibodies, 80-83 searching for new, 80-96 vaccines, 87-89 Tracking the epidemic, 14-25 HIV case reporting, 16-19 national AIDS surveillance system, 15 population-based HIV incidence estimation, 19-23 rationale for a national system of HIV surveillance, 16 Training, integrating HIV prevention early in health professionals’, 54 Transfusion-related infections, 35 Translating research into action, 6-7, 68-79 barriers to effective technology transfer at the community level, 72-74 current efforts in prevention technology transfer, 68-72 opportunities for improving prevention technology transfer, 74-77 Translation of prevention research into practice, requests for public comment on, 187 Transmission modes of, 140-142 trends in, 140-142 Treatment of co-occurring conditions, interventions to prevent HIV infection, 156 Trends in the United States, 139-148 AIDS and co-occurring conditions, 147-148 changing demographic face of the epidemic, 142-146 modes of transmission, 140-142 Tuberculosis, 52, 147-148 U Uganda, National AIDS Control Programme in, 105 United States adult correctional systems in, 122 Standard Metropolitan Statistical Areas in, 41 trends in, 139-148 U.S. General Accounting Office (GAO), 34 U.S. Preventive Services Task Force Guide to Clinical Preventive Services, 51 V VA. See Department of Veterans Affairs Health Care System Vaccine research under the National Institutes of Health, 167 return on investment issue, 88 Vaccine Research Center, 167 Vaccines, 87-89 advances in, 7 W Western Blot test, 81n, 82 WHO Ad Hoc Committee on Health Research, 90 William and Flora Hewlett Foundation, 90 Women AIDS cases in, 142-143 funding programs aimed at, 46, 189 health care settings utilized by, 56 programs for under the Ryan White CARE Act of 1990, 170 1999 Work Group Report on HIV Prevention Activities, 74 Workability, evaluating HIV prevention programs for, 192

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No Time to Lose: Getting More from HIV Prevention World Bank, 90 Y Youth AIDS cases in, 143-144 health care settings utilized by, 56 programs for under the Ryan White CARE Act of 1990, 170 Z Zidovudine (ZDV), 34, 142, 156