Advancing HIV Prevention: The Four Strategies

HIV/AIDS

An estimated 40,000 new HIV infections occur in the United States, each year. These new infections include over 300 infants who contract HIV because their mothers are infected. Available evidence suggests that the majority of new infections is caused by persons unaware of their HIV infection, and an estimated one-quarter of those who are infected with HIV do not know they are infected.

CDC's new initiative emphasizes HIV testing, in both medical and non-medical settings, to identify infected persons who are not aware of their own infection and getting them into treatment and prevention services.

Program Outline

1. Incorporate HIV testing as a routine part of care in traditional medical settings. CDC will issue recommendations strongly encouraging all health care providers to include HIV testing, when indicated, as part of routine medical care, like other routine medical tests by:

• Promoting removal of real and perceived barriers to routine testing, including "de-coupling" HIV tests in the medical setting from extensive, pre-test prevention counseling. In some jurisdictions, statutory requirements, e.g. for pretest counseling, can serve as barriers to testing.
• Working with professional medical associations and others to promote adoption of the recommendations. CDC will work with public and private payors to promote appropriate reimbursement incentives.

2. Implement new models for diagnosing HIV infections outside medical settings. Some persons infected with HIV do not have access to traditional medical settings. CDC will create new program models to increase HIV testing in high-prevalence, non-medical settings by:

• Encouraging the use of the HIV rapid test.
• Funding pilot projects in 2003, aimed at identifying the most effective models for HIV diagnosis and referral for medical and preventive care which CDC grantees can employ outside traditional medical settings.
• Taking steps to assure that 2004 funding is used to support such models through CDC grant programs to health departments and community-based organizations.

3. Prevent new infections by working with people diagnosed with HIV and their partners. CDC will promote preventive and treatment services within and outside traditional medical settings by:

• Working with HRSA to reach those who have been diagnosed with HIV but who are not receiving ongoing treatment and preventive care services. CDC in consultation with HRSA will publish and disseminate "Recommendations for Incorporating HIV Prevention into the Medical Care of Persons with HIV Infection" in 2003.
• Conducting demonstration projects through health departments to provide prevention case management and counseling for people living with HIV.
• CDC will standardize new procedures for prevention interventions and evaluation activities to assure that such measures are both appropriate and effective. In accordance with these new procedures, CDC will broadly implement prevention services for people living with HIV through health departments and community-based organizations by refocusing CDC 2004 funding on activities with proven effectiveness.
• CDC will assure that requirements related to partner notification in grant guidance are fully met so that this recognized technique of infection control is optimally employed. Additionally, CDC will pilot new approaches to partner notification, including offering rapid HIV testing to partners and using peers to conduct appropriate partner notification, prevention counseling, and referral.

4. Further decrease mother-to-child HIV transmission. Treatment of pregnant women and their infants can substantially reduce the number of babies born with HIV infection. Such interventions are most effective when the HIV status of the pregnant woman is known as early as possible in pregnancy -and if not known-when the baby can be tested at the time of birth. CDC will:

• Promote screening of every pregnant woman for HIV, using the "opt-out" approach. Make prenatal HIV screening a routine part of medical care.
• Promote screening of newborns whose mothers HIV status is not known.