Stanford Report Online

Stanford Report, October 4, 2000
Report encourages new national strategy for preventing HIV infections


Efforts to stop the spread of the virus that causes AIDS have slowed the epidemic in recent years, but the rate of new infections is still too high, said a new report on AIDS prevention from the Institute of Medicine (IOM). Renewed efforts in AIDS prevention are particularly important now because in some groups and in some regions of the country the infection rates for the AIDS virus (HIV) are rising, said Stanford assistant professor of medicine, Andrew Zolopa, one of the members of the committee that compiled the report.

The committee, which was composed of many national figures in the fields of AIDS research and public health, recommended that authorities adopt a national strategy to better track HIV infections, and that funding be funneled to the most cost-effective prevention programs.

In the last 15 years AIDS has declined dramatically among gay men, while at the same time there has been a large increase in AIDS in women, minorities and adolescents. In addition, the effectiveness of new AIDS drugs has given people a false sense of security about their risk of being infected with HIV and has also increased the pool of people who carry the virus and can infect others. The IOM study, called No Time to Lose: Getting More from HIV Prevention, resulted from a request by the Centers for Disease Control and Prevention for recommendations on how to prevent such a shifting epidemic.

One of the major recommendations of the committee is to create a new national surveillance system that will spot where new infection rates are the greatest. "Part of the problem of a national tracking system that is based on AIDS cases reported to the CDC, is that AIDS is at the end of a very long process," said Zolopa. "When we look at the rate of new AIDS cases, we are looking at infections that happened eight or 10 or more years ago." Active surveillance of blood samples taken in hospitals and clinics would give public health officials a better idea of where hot spots of HIV infection are. The report recommends that the screening be done in a completely anonymous fashion.

Knowing where new infections are greatest would give public health officers the best chance of curbing the spread of HIV infection. "The problem now is that money for prevention is allocated pretty much according to how many AIDS cases there are," said Zolopa. "The report points out that this is not the most effective way to prevent HIV infections, since the dollars are not necessarily going to where the greatest infections are happening now, but where they happened years ago."

Another key element of the report was a recommendation that money for HIV prevention be directed to where it is most effective. Although that may sound obvious, said Zolopa, cost-effectiveness has not been the primary concern in allocating money so far. For instance, said Zolopa, for a long time we have concentrated on making sure the nation's blood supply is free of HIV. The result has been a blood supply that is very nearly pure, but there will always be some infected blood that slips through the screening. "There are so few lots of infected blood out there now that it turns out that preventing the one HIV infection from a blood transfusion costs something like $7.5 million," Zolopa said. Needle exchange programs or condom giveaways may be much more effective for the money, he added.

Zolopa has spent considerable time studying how best to bring the message of HIV prevention to AIDS clinics. "Traditionally there has been a great wall that separates AIDS prevention from AIDS treatment programs," Zolopa said. The IOM committee recommended that physicians deliver the prevention message more often through AIDS clinics. "If you are going to prevent HIV infections, you have to reach out to the infected population; and clinics are the best place to do that," Zolopa said.