Academy for Educational Development

Washington, D.C., January 15, 2004 — Key policy makers addressing the next phase of HIV prevention and care pointed to stigma reduction, behavior change activities and integration of prevention into care as essential elements in stemming the spread of the virus around the world.

Speaking at a symposium titled "Moving to the Next Phase in HIV Prevention," sponsored by the Academy for Educational Development (AED) in Washington, D.C., Andrew S. Natsios, Administrator for the U.S. Agency for International Development (USAID), said "the urgency of containing and defeating the HIV/AIDS pandemic is one of the defining issues of our era." Nearly 300 people attended the symposium.

Saying he is "more optimistic now that conditions are ripe to slow the pandemic's spread," Natsios noted that AIDS funding has increased substantially and said the Bush Administration has the correct strategy, "which is field driven and technically based."

According to Natsios, stigma reduction, food security and a balanced behavior change approach are critical in the fight against AIDS. He emphasized the need for expanding community-based programs to national levels and the importance of forming new partnerships to combat the disease globally. USAID's top official called religious institutions, "the most powerful force for changing behavior in any society" and noted that, if efforts to fight HIV/AIDS ignore the important role religion plays in many of the countries ravaged by the disease, they will not succeed.

Natsios' strong support for increased prevention efforts was echoed by a panel of experts from USAID, AED and the Centers for Disease Control and Prevention.

According to Constance Carrino, Director of the USAID Office of HIV/AIDS, "high-risk behavior by high-risk groups are driving the epidemic." Those groups include prostitutes, drug users, men who have sex with men, and youth. Because the most rapid infection rates are seen among youth, Carrino said they are an important target of prevention efforts. The success of those efforts, she said, hinges on messages getting to the right places and being delivered by important religious and political leaders and through face to face interaction.

Carrino also stressed USAID's focus on medical transmission of HIV, the integration of food and nutrition, and the integration of HIV prevention and family planning activities.

Calling for a "social vaccine" against HIV, Frank Beadle de Palomo, director of the AED Center for AIDS & Community Health, told those attending the symposium, "While we need prevention, care, treatment, and research, if we don't focus on the benefits of prevention, we're going to lose the battle."

Beadle suggested a new "ABC" strategy that should include Action, Behavior change and Comprehensive approaches to curtailing the spread of AIDS. Such programs would be multisectoral, including the religious community, the media, girls' education, and food security. They would also require greater political will and making "positive people partners in prevention," said Beadle.

He noted the importance of dealing with stigma and discrimination, which are "at the root of the epidemic in Africa, Asia and the United States." Looking at best practices and lessons learned in the 17 years AED has worked in AIDS, Beadle singled out access to condoms as an important strategy and cautioned that abstinence should be "talked about as part of a comprehensive approach and not the only approach." He also discussed the need for communicating explicit messages to high risk populations, saying, "If we cannot speak about what we expect folks not to do, how can we expect them not to do it?"

Ronald O.Valdiserri, deputy director of the National Center for HIV, STD, and TB Prevention at the Centers for Disease Control and Prevention (CDC), said "prevention is even more critical than it was in the early days of the epidemic" due to higher prevalence. The success of treatment has also changed public attitudes toward HIV/AIDS and presented an added challenge for prevention efforts. "Fewer and fewer Americans are identifying HIV/AIDS as the most urgent health problem facing our nation today," he said.

Valdiserri pointed to four strategies to reenergize HIV prevention efforts that apply to the industrialized and the developing world. They are to socially market HIV diagnosis; integrate prevention into care; develop and sustain competencies needed for HIV prevention; and continue to invest in vaccine, microbicide and behavioral research. Like his colleagues on the panel, he advocated a comprehensive approach because there is no one solution or simple answer to AIDS. "HIV prevention is a powerful and important tool," he said, "but we have to able to sustain it, if we want to achieve results."

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