Wall Street Journal - February 7, 2001
Mark Schoofs, Staff Reporter

CHICAGO -- The U.S. Centers for Disease Control will unveil a major shift in its AIDS-prevention strategy Wednesday in an effort to reduce by half the number of Americans who each year contract HIV, the AIDS virus.

But CDC officials said they aren't certain they can get the money such an effort requires because of the uncertainty over funding as a result of the new administration in Washington.

To cut infections in half, the CDC's AIDS-prevention program will need about $900 million a year, said Helene Gayle, director of the agency's AIDS program. Currently, the CDC's prevention efforts have an annual budget of about $700 million, said Dr. Gayle. She said she didn't know how much the CDC would formally request because the transition to a new administration has left the budget process unclear.

The CDC's new program would aim to reduce the annual number of new HIV infections in the U.S. to 20,000 people from 40,000 people. Central to the plan would be a strategy in which the CDC and other government health programs would target those people already infected and try to counsel them against spreading the virus. This approach marks a strong shift in CDC prevention tactics, as most previous efforts were directed at uninfected people.

Targeting infected people -- the source of every new infection -- has become possible, said Dr. Gayle, because the powerful AIDS-drug cocktails "have changed the landscape." People are much more willing to be tested and come into care, because they get the benefit of drugs. Researchers estimate that one-third of infected Americans aren't aware that they carry the AIDS virus.

But CDC officials privately said the agency hasn't had enough money to focus on those infected already. Tommy Thomson, the new secretary of health and human services, said in a meeting with the department's top staff last week that AIDS is a top priority.

A HHS spokesman, Bill Hall, said that prevention is important to the Bush administration, but that no decisions on funding can be made yet.

The new initiative, to be announced at a major AIDS science conference being held this week in Chicago, comes in the midst of distressing new data. A six-city CDC study, also released this week, found that before gay black men turn 30 years old, some 30% of them become infected with HIV. That is comparable to the hardest-hit countries in sub-Saharan Africa.

What's more, African-American gay and bisexual men are no fringe group in the U.S. AIDS epidemic. They account for more than 40% of all AIDS cases among African-American men. In turn, African Americans account for about half of all new HIV infections in the U.S., according to the CDC.

Those figures "should motivate us to say, 'What in the hell are we doing wrong?' " said former Congressman Ron Dellums, who is a leading advocate on AIDS issues. Although Mr. Dellums said he believes it is important to publicize the new data as a way of getting more government funding to prevent more infections, he said he is worried the statistics could backfire.

"If people get it in their heads that it's a minority issue that doesn't affect them, then they will step away from it," he said in an interview at the AIDS meeting here. "With a trillion-dollar surplus, it would be obscene not to spend a measly $300 million to bring down the rate of infection," Mr. Dellums said.

The six-city study also found that 15% of young Hispanic gay men are HIV-positive, compared with 7% of white gay men and 3% of Asian gay men.

That study, like several others presented at the Eighth Conference on Retroviruses and Opportunistic Infections, suggested that gay men of all races are engaging in unsafe sex. Another study from the Bronx, N.Y., found that inner-city heterosexuals also have high rates of unprotected sex.

Most worrisome is that many of the people engaging in unsafe sex are infected with HIV, meaning that they can pass it on. In 1999, only 37% of publicly funded programs targeted HIV-positive people. "We need to change that," said Robert Janssen, a senior CDC doctor, in a press conference previewing the CDC proposal at the Chicago AIDS conference Tuesday. "What we hear from individuals with HIV is that they do not want to pass on the virus. The challenge will be helping them maintain safer behaviors over the long run."

Write to Mark Schoofs at mark.schoofs@wsj.com

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