AIDSWEEKLY Plus, Monday, 25 November 1996
Daniel J. DeNoon, Senior Editor

"We look forward to changing the number of new HIV infections in this country to zero," said Helene Gayle, director of the National Center for HIV, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.

Gayle spoke in a featured address to the International Society for HIV/AIDS Education and Prevention's Tenth International Conference on AIDS Education, held November 9- 13, 1996, in Atlanta, Georgia.

"What I want to get across if nothing else is how comprehensive the prevention effort must be and how much we must involve the community," Gayle said. "It is really the way we get all our HIV prevention planning activity done now."

The AIDS program director did acknowledge that the CDC has a long way to go. "We would like to be in a situation where we aren't playing catch-up," she said. "We haven't been doing prevention over the last few years, we have been doing clean- up."

The CDC's current approach, she said, is to seek partnerships with community organizations planning HIV prevention programs. She listed several advantages to this approach: partnership promotes community input; applies a strong scientific basis to decision-making for HIV prevention programs; builds grass-root support for programs; improves the quality of program decision-making; and provides for a more equitable distribution of resources.

Foremost among problems encountered by the CDC when working with community groups is ensuring that the group itself is a meaningful representation of the community, Gayle said. "It's really difficult in a process that is new to make sure who is brought to the table includes the people most needing the program and not just the loudest or most powerful," she said.

Other challenges include discordant perspectives (within the community, and between the community and CDC); "analysis paralysis" (i.e., never moving to program implementation); and role evolution as programs move from planning to actualization.

Gayle said that programs most likely to work - and hence to achieve partnership with the CDC - are those that are based on specific needs; are culturally competent; target a defined audience, objectives, and interventions; reflect behavioral and social science lessons; include quality monitoring; and include evaluation and midcourse corrections.

The CDC plans to focus on groups representing people at highest or increasing risk of acquiring HIV infection. Such populations include intravenous drug users, young gay men (particularly from racial minorities), and women.

The CDC also plans to increase integration of AIDS prevention programs with related programs, especially those related to prevention of tuberculosis and sexually transmitted diseases, and to reproductive health services.

To augment behavioral AIDS prevention, the CDC will maintain its commitment to biomedical interventions, said Gayle. This includes research into vaginal microbicides, STD treatments, treatments for AIDS related opportunistic infections, the effects of anti-HIV drugs on virus transmission, and vaccines.

"The development of AIDS vaccines is going to be an important step, especially in developing countries," Gayle said. "Vaccines will have a major, major role to play in the global epidemic."

During a question-and answer session, Gayle defended the CDC's decision to continue stressing universal AIDS education: "I still think that the message is that anyone can get HIV if you have the risk behavior," she said. "Everybody is not at equal risk and that is the reality, but everybody needs to be able to evaluate what the risk is."

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