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Volume 35
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Bush Administration criticized for poor HIV prevention plan among African-Americans
Bush Administration criticized for poor HIV prevention plan among African-Americans
No new money, no new strategies and gay men ignored, they say

New York, NY - As the Bush administration announces its long-awaited initiative for HIV prevention for the Black community this Thursday at CDC in Atlanta, people living with HIV/AIDS, researchers, and policy and program leaders from the African-American community slammed the program as "too little, too late," and void of substance on issues crucial to the Black epidemic.

The new initiative, developed by the Centers for Disease Control and Prevention (CDC), was released simultaneously with a sobering epidemiological report on HIV in the United States in the Morbidity and Mortality Weekly Report (MMWR). It also comes at the same time that organizations on the frontlines of the Black epidemic face potentially fatal funding cuts, as the federal Minority AIDS Initiative has completely suspended payments until it is re-organized as a competitive bidding process this fall.

Urging the AIDS community to "follow the money" amidst the fanfare of the initiative's roll-out, advocates note that HIV testing funds re-announced as part of the initiative do not meet the need and have not been approved by Congress. Significantly, no new funds are allocated for community-based HIV prevention programs.

CDC is framing the initiative as a "heightened national response" with four components:

Expanding the reach of prevention services by bringing in new partners
Noting that researchers, community-based organizations, advocacy groups, members of Congress and state legislators are asking for structural changes in the approach to the epidemic, Dr. Robert Fullilove critiques the reliance on new partnerships, noting that "CDC has not heeded the call by being more aggressive in pursuing better HIV care and prevention in prisons, and is not working harder to promote changes in neighborhood housing policies that would stabilize the conditions that drive the epidemic. Instead, CDC seeks to place the burden on private organizations that are often poorly funded and ill-equipped to deal with an epidemic that has raged out of control for a quarter of a century."

Acknowledging CDC's limited effort to engage community feedback before launching its initiative, Judith Dillard declares, "How many more consultations on African-Americans and HIV will the CDC need to have in order for them to realize that HIV, as a state of emergency in the Black community, needs new money, new approaches - real resources for our community? These new data shouldn't be a surprise to anyone who's been paying attention, but where's the housing, the prison sentencing reform, the programs for women, Gay men and drug users, the programs we so desperately need? Will new partners bring us closer to real reform?"

Increasing opportunities for HIV testing and treatment
Last year, CDC shifted to a universal routine screening approach to expand HIV testing through clinical settings - which could cost $864 million if fully implemented, according to Dr. David Holtgrave of Johns Hopkins Bloomberg School of Public Health.

"The Bush administration has summoned urgency around a narrow approach to addressing the HIV crisis in the Black community," commented Dr. Walt Senterfitt, an HIV-positive epidemiologist. "It focuses resources and attention on testing, while neglecting other crucial elements of an effective and comprehensive response that includes prevention, care, and addressing the structural factors driving the epidemic," Advocates have questioned where people who are newly diagnosed will go for care and expressed concern about how to meet the need for HIV prevention programs among people at high risk for infection.

President Bush's overall budget request for domestic HIV prevention in 2008 is $400 million below the approximately $1.4 billion experts say is needed to achieve the CDC's goal of reducing new infections by half. And it includes no new resources for community-based HIV prevention programs.

Bush has requested a modest $63 million in new funding for 2008 in order to test two million people, mostly African-Americans. The expanded testing will be targeted for the ten cities with the highest number of new HIV infections, with an emphasis on reaching injecting drug users and people who are incarcerated. However, the proposal does not call for evidence-based HIV prevention programs to accompany testing in those communities, such as condom availability in correctional settings and clean syringe exchange programs. CDC claims that the testing proposal will avert 1,500 new HIV infections, which would achieve only 7% of its stated goal to cut new infections by half each year from 40,000 to 20,000.

There is a funding shortfall for the AIDS Drug Assistance Programs (ADAP), which could reach $205 million in 2008 if Bush's budget request is approved. On March 1st, the Bush administration suspended funding for the Minority AIDS Initiative, which supports programs that help link newly diagnosed HIV-positive African-Americans into care.

Developing new and effective prevention interventions, through research on new prevention programs and adaptations of existing interventions
"I welcome more research into HIV prevention in the African-American community, especially for Black Gay Men," said Mark McLaurin, Executive Director of the New York Black Gay Network and a CHAMP Board member. "But it will take more than changing the face on a brochure or an outreach poster from a White one to a Black one to come up with programs that work. Many of the problems with this initiative come down to CDC's failure to speak the truth about what's needed and insist on resources to make it happen."

McLaurin continued, "This is the first time the Bush administration and CDC have acknowledged that a majority of new HIV infections in the Black community are among Gay men. But they have presented no targeted strategies for how to address this shocking reality."

CDC estimates that 51% of all new HIV infections in the African-American community are among Gay men and other men who have sex with men (MSM). A CDC five-city survey published in 2005 found that, on average, 46% of Black Gay Men and other MSM were HIV-positive

. Launching a new community mobilization effort called Awareness, Communicate, and Test (ACT)
CDC announced the initiative during the National Black Church Week of Prayer for the Healing of AIDS and emphasized reliance on faith-based and other private partners as a key strategy. "Black churches and community organizations have already been at the forefront of fighting AIDS, but the Bush administration cannot bait-and-switch the community by forgoing the federal government's responsibility for the health needs of all its citizens," said Judith Dillard, an African-American woman living with HIV and CHAMP Board member. "There's only so far President Bush's stingy prevention budget can be stretched, and the burden falls back on our communities."

Research shows that individual behavior does not explain the exponentially higher rates of HIV among Blacks compared with Whites, suggesting that structural factors such as housing and incarceration play a larger role in driving the epidemic. "It's hard for people to protect their health if they don't have stable housing or are stuck in the revolving door between prison and their community," said Judith Dillard, who became homeless after receiving her HIV diagnosis.

Bush's budget request for the Housing Opportunities for People with AIDS (HOPWA) program is $150 million below what's needed for 2008, and his overall request for the Department of Housing and Urban Development (HUD) represents an 8% cut below this year's funding level.

A CHAMP press release

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