Petrelis Files

CDC FINALLY LAUNCHES ASSESSMENT OF HIV PREVENTION


Friday the 13th was a lucky day for me, and, by extension, for the gay male community because it was the day the Centers for Disease Control and Prevention sent a letter to Rep. Mark Souder, R-IN, stating the federal agency was “developing plans to periodically review all grantees to assess their effectiveness.”

This relatively innocuous statement represents an enormous shift for the CDC in that the agency, instead of continually shoveling millions of dollars for HIV prevention at local nonprofits without demands that the they produce effective workshops and messages that actually prevent new HIV infections, will soon measure the effectiveness of CDC-funded groups.

Believe it or not, up until now, the CDC has not insisted on proof that its HIV prevention partners at the grassroots level actually reduce the number of new infections, but thanks to my efforts with Souder’s staff, that is about to change.

I’ve worked with Souder pointing out what I believe are ineffectual programs of the Stop AIDS Project, funded by CDC. It’s taken almost three years for CDC to agree with us that asking the Stop AIDS Project, and all HIV prevention groups funded by the agency, produce evidence documenting that their programs are meeting their stated goals of averting new infections.

Sure, Souder’s staff and I have been vilified for even asking that the Stop AIDS Project prove its effectiveness, amid claims by the San Francisco Department of Public Health that the city is undergoing sub-Saharan levels of HIV transmissions, but the vilification really does not matter, because in the end, the CDC will now assess the project’s effectiveness.

This assessment will assist the gay community in San Francisco in evaluating HIV prevention endeavors and their supposed worthiness. For more years than I care to count, no one bothered has asked the Stop AIDS Project to demonstrate its effectiveness, and thanks to Souder listening to me, that is about to change.

With the CDC doling out grants for seemingly endless and pervasive social marketing campaigns targeting gay men wherever we gather in San Francisco, whether for sexual liaisons or a simple cup of coffee, along with flirting classes and annual Geezer Balls, workshops on how to negotiate relationships with rent boys and male escorts, a four-part workshop on cruising the web for sexual sites and connections, it has long been time for the federal government to prove, with hard scientific evidence, such campaigns reduce HIV transmissions.

I am happy to be alive to witness this change on the CDC’s part and will always remember this Friday the 13th as the dawning of a new day for much-needed AIDS accountability.

Below is the text of the letter CDC sent to Sounder yesterday.

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June 13, 2003

The Honorable Mark E. Souder
House of Representatives
Washington, DC 20515

Dear Mr. Souder:

I am writing in follow-up to my letter dated February 13, 2003, and to address concerns raised by your staff regarding the effectiveness of HIV prevention efforts in general and, more specifically, about recent activities of the Stop AIDS Project. I hope to meet in person with you soon to discuss these issues further since I know we share a commitment to reduce the incidence of HIV and apply effective methods in preventing infectious diseases through the Centers for Disease Control and Prevention’s HIV prevention activities.

CDC has a longstanding history of building effective public health programs on a solid foundation of the best possible surveillance data. Over the past two decades, the sensitivity of the HIV/AIDS issue has often made it difficult to obtain precise information about incidence. However, advancements in technology now offer new tools for securing a more accurate estimate of HIV incidence. Specifically, a new assay allowing us to determine how recently individuals became infected should contribute to great accuracy of information about new infections. CDC will continue to take advantage of new technologies, such as the new assay, to ensure that our prevention efforts are driven by the best possible data that ultimately will help us achieve the goal of reducing HIV incidence.

I am also deeply committed to ensuring the efficacy of CDC-funded programs and will take steps to make sure that appropriate measures are in place to achieve the desired results. To follow through on this commitment, we are developing plans to periodically review all grantees to assess their effectiveness, as well as intensify our efforts to assess compliance with statutory and grant management requirements. I look forward to discussing these steps with you personally.

In addition to your concerns about the general effectiveness about CDC’s HIV prevention programs, you have communicated to CDC your specific concerns regarding the CDC-funded activities of the San Francisco Stop AIDS Project. I, too, share your concerns. Under Section 2500 of Public Health Service Act, it is illegal to use federal dollars intended for HIV/AIDS prevention programs designed to promote or encourage, directly, sexual activity. As the Director of CDC, I am committed to ensuring that CDC funds are not used in this manner.

Recent experiences with the Stop AIDS Project indicate that CDC current approach of utilizing community boards to review local program activities in not adequate to ensure compliance with Section 2500. Recent Stop AIDS workshop titles and program descriptions that involve, for example, advice on promoting relations with escorts and prostitutes, in my view, appear to violate Section 2500. Workshops that are consistent with such program titles would also appear to violate Section 2500. In order to rectify this situation, CDC is taking the following actions:

- A letter is being sent to the Stop AIDS Project to provide notice of the appearance of a violation to refrain from using program titles, descriptions, marketing materials, or programs that are designed to directly promote or encourage sexual activity, including prostitution.

- A letter is also being sent to the San Francisco Department of Public Health reminding them of their responsibility to ensure that materials approved by the Program Review Panel, under the auspices of their office, are consistent with provisions of Section 2500.

- CDC will notify HIV prevention program grantees about their obligations to comply with Section 2500.

- CDC is revising its guidance to grantees to provide clear and specific instructions regarding compliance with Section 2500.

- In the case of directly funded community-based organizations, CDC will intensify oversight of grantee activities to determine compliance with relevant CDC guidance.

- CDC will take action to ensure that accountable sate or local health officials independently review federally-funded HIV prevention materials for compliance with Section 2500 and approve the use of such materials in their jurisdiction for directly and indirectly funded organizations.

- All grantees will be required to certify they are complying with revised CDC guidelines. Programs that refuse to comply will not be eligible for federal funding. CDC will also conduct reviews of grantees, including Stop AIDS, to ensure compliance with federal law, regulations, and guidelines.

I appreciate your continued interest in this important public health issue and look forward to meeting with you to discuss these and other areas of interest.

Sincerely,
Julie Louise Gerberding, MD, MPH
Director
Centers for Disease Control and Prevention