Jono’s Journal

For the past 21 years, World AIDS Day has given all of us engaged in the fight against HIV/AIDS an opportunity to share our stories with the world. This year’s international theme, Universal Access and Human Rights, could not have been more relevant to us—especially considering the health care debate that is ongoing in this country—because it served as a reminder of the need to continue our work bringing effective prevention and care to the people who need them most.

So, too, was our federal theme, Working Together. Whether we are scientists, physicians, nurses, researchers, people living with HIV/ AIDS, activists, community-based organizations, elected officials, public health professionals, or government agencies, we must increasingly work together to turn the epidemic around during a time of budget challenges and reduced concern about HIV among the American public. Every person has a role and a responsibility in the fight against HIV/AIDS.

Along with public health partners, it is important to recognize that physicians and other health care providers are also on the front lines in the battle against the spread of HIV. They are important allies in preventing and treating this disease. In this issue of DHAP News, we feature an article about Prevention IS Care, a phase of the Act Against AIDS campaign that focuses on getting health care providers the information they need so they can talk about HIV prevention with their HIV-positive patients at every visit.

Patients diagnosed with HIV reduce risky behaviors when they are diagnosed, and HIV transmission among HIV-discordant couples—where one partner has HIV and the other does not—is reduced 80%–90% with shared knowledge of HIV status, education, and access to condoms. However, people’s lives, relationships, and sexual activity change over time, so providing people living with HIV ongoing support to maintain behavior change is critical.

Health care providers can exert strong influence over their patients’ behaviors and play an essential role in preventing HIV transmission. So it is important that providers keep talking about prevention with their HIV-positive patients at every opportunity.

In the December issue, we also look at World AIDS Day activities, the Medical Monitoring Project, and an interactive Flash module that was introduced at the National HIV Prevention Conference this past summer. The module is called The State of the Epidemic: HIV Incidence in the United States, and it is a new and innovative way of communicating surveillance information using incidence data from 2006. We introduce a new section of the newsletter—Act Against AIDS Update—that will provide, in every issue, the latest information on CDC’s national communication and HIV prevention campaign. We invite you to comment on DHAP’s portion of the Healthy People 2020 national framework for health promotion and disease prevention and share the good news about the lifting of the travel ban for people with HIV/AIDS who want to come to the United States. You will also read about the good work the Gay Men’s Health Crisis is carrying out in New York through the successful implementation of two evidence-based behavioral interventions. DHAP News will have a standing feature in every issue that showcases the critical and life-saving work of our partners as they put into practice proven prevention interventions.

Thank you for your dedication to ending the HIV epidemic. On behalf of the division, I offer warmest wishes for a wonderful holiday season.

As always, I value your advice and encourage you to send your perspectives and ideas to me at DrMerminsCommentBox@cdc.gov. I look forward to hearing from you.

Jonathan Mermin, MD, MPH
Director
Division of HIV/AIDS Prevention

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DHAP Embraces Action and a Spirit of Collaboration for World AIDS Day

On December 1, the 21st World AIDS Day, governments, national AIDS programs, faith organizations, community organizations, and individuals at CDC and around the world joined forces to raise awareness and focus attention on the global epidemic. It was a day to remember those whose lives have been lost and reflect on the ongoing effects of HIV and AIDS on our communities, our nation, and our world.

This year’s international theme was Universal Access and Human Rights. The federal theme in the United States was Working Together. For more information, visit CDC Feature.

"Because our theme in the U.S. was Working Together, we wanted to live it,” said Stephanie Creel, a health communications specialist with the Prevention Communication Branch and coordinator of CDC’s World AIDS Day events. We worked closely with some of our critical partners such as the HIV Medicine Association (HIVMA), the American Academy of HIV Medicine (AAHIVM), and Clinical Care Options (CCO), who joined with us to send HIV prevention messages to their memberships.

For example, on World AIDS Day, CCO wrote a cover story including CDC’s provider messaging that they sent to 58,000 international HIV providers (26,509 in the U.S.) and 10,000 hepatologists. The directors of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention and the Division of HIV/AIDS Prevention reached out to HIVMA and AAHIVM, emphasizing the importance of their work to help stop the spread of HIV. Dr. Mermin said, “In the early days of the epidemic, health care providers played a key role in research to identify effective treatments and have helped extend the length and quality of life of countless Americans living with HIV and AIDS. Their role remains just as important today, not only for treating those with HIV, but also for helping to stop new infections.”

On the eve of World AIDS Day, senior Administration officials discussed how the Obama Administration is addressing HIV/AIDS issues, including developing a national HIV/AIDS strategy to bolster our response to the domestic epidemic and a global health initiative to build on the success of the President’s Emergency Plan for AIDS Relief.

Read President Obama’s World AIDS Day proclamation.

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Prevention IS Care Phase of Act Against AIDS Promotes Health Care Provider Influence on Prevention for Persons Living with HIV

Studies have shown that health care providers exert a strong influence on patients’ behaviors. Even brief provider-delivered approaches have been effective with a variety of health issues, and similar approaches may be effective in reducing transmission risk behaviors of HIV-infected patients.

Studies also show that health care providers need science-based prevention guidance and interventions in treating their HIV-infected patients. CDC created Prevention IS Care so that relevant, ever-evolving information can be provided to health care providers who care for patients with HIV infection.

Prevention IS Care offers tools such as posters, fliers, articles, and provider education to help providers sustain an ongoing conversation about risk behaviors with their HIV-positive patients.

The goal of Prevention IS Care is to encourage providers to talk about HIV transmission prevention during every patient visit so that HIV-infected patients remain vigilant about avoiding risky behaviors.

By focusing on prevention, providers will help their patients stay healthy and protect the health of others, help reduce HIV transmission, and make a positive impact on the HIV epidemic.

Prevention IS Care recognizes the power of health care providers who treat HIV-infected patients. To expand the reach of this effort, partnerships have been developed with key health and HIV/AIDS organizations such as the HIV Medicine Association and the American Academy of HIV Medicine.

State health departments and other HIV prevention practitioners are encouraged to use Prevention IS Care materials in their outreach to health care providers.

Learn more about Prevention IS Care.

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Providing Funds to CBOs Furthers CDC’s Ability to Fight the HIV/AIDS Epidemic

Community-based organizations (CBOs) are vital CDC partners in preventing the spread of HIV and AIDS. Because these organizations best know their communities, CDC makes funding opportunities available to CBOs with documented experience working with the target populations and providing services in their geographic areas.

Now that the application deadline for PS10-1003, “HIV Prevention Projects for Community-Based Organizations,” has passed, the rigorous process of assessing applications has begun. Applications are reviewed for completeness by CDC’s Procurement and Grants Office (PGO) and for responsiveness to eligibility criteria jointly by DHAP, NCHHSTP, and PGO. For the total project period (up to 5 years) funding, CDC expects to award approximately $231 million under this announcement. This estimated amount includes direct and indirect costs and is subject to availability of funds.

In early 2010, eligible applications will be evaluated by an independent external review panel assigned by CDC, known as a special emphasis panel (SEP). During the SEP process—which involves multiple reviewers, all with expertise in some area of HIV/AIDS prevention—panel members score the applications using evaluation criteria specified in the funding announcement. Once that review is complete, pre-decisional site visits (PDSVs) will be conducted. During the PDSV, the applicant’s ability to accomplish these criteria is evaluated: effectively and efficiently implement the proposed HIV prevention interventions; demonstrate experience with, and the ability to identify and address the needs of, the proposed target population; and effectively and efficiently sustain the proposed program.

Awards will be based on overall scores from the SEP review, the results of the PDSVs, and application of CDC’s funding preferences. For HIV prevention program applicants, funding preference will be given to ensure that funded applicants are distributed approximately in proportion to the HIV epidemic in terms of targeted racial/ethnic minority groups, targeted risk behaviors and HIV serostatus, geographic distribution, and targeted gender.

For outcome monitoring applicants, funding preference will be given to agencies implementing evidence-based interventions designed or adapted for men who have sex with men at high risk for transmitting or acquiring HIV; secondary funding preference will be given to agencies implementing interventions designed or adapted for African Americans and/or Hispanics/Latinos at high risk for transmitting or acquiring HIV.

From mid-June through June 30, awards will be made; and the project period starts on July 1, 2010. For community-based HIV prevention programs, CDC expects to award up to 145 cooperative agreements, with an average award of $300,000. For the monitoring and evaluation projects, CDC hopes to be able to make awards to up to 24 of the 145 HIV prevention program awardees; average award will be approximately $75,000 in the first year and increased to approximately $150,000 in subsequent years because of anticipated increase in activities. The funding period for both categories of awards is up to 5 years and is based on availability of funds.

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DHAP QuickFacts

Number of Effective Behavioral Interventions That Are Packaged and Available Through the Diffusion of Effective Behavioral Interventions (DEBI) Project, 2001 – 2009

This figure shows the number of HIV prevention interventions that are available through the DEBI project. The DEBI project is designed to increase the number of evidence-based individual-, group-, and community-level interventions that can be used in local HIV prevention programs. These interventions are identified through systematic reviews of the scientific research literature that use rigorous criteria to evaluate the design, implementation, and results of HIV prevention intervention studies. Since 2001, the number of DEBI interventions has grown from 5 in 2001 to 26 in 2009 (year to date). More than 10,000 individuals and 5,000 organizations have participated in training on these DEBI interventions.

For more information, visit the DEBI Web site.

Data Source: Capacity Building Branch, DHAP

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Unique DHAP Surveillance Project Seeks to Provide Clear Picture of HIV/AIDS Care in the United States

In 2004, DHAP implemented the Medical Monitoring Project (MMP), the most comprehensive surveillance project of its kind. The ongoing project will provide information about the behaviors, medical care, and health status of people living with HIV/AIDS by examining comprehensive clinical and behavioral information from patient samples carefully selected to represent everyone receiving medical care for HIV in the United States.

According to Rita Morgan, deputy team lead of the Clinical Outcomes team in DHAP’s Behavioral and Clinical Surveillance Branch, 2009 has been a breakthrough year for the MMP.

“The first cycle of the project started in 2004, and was a pilot project for the first couple of years,” Morgan said. “We’ve had a lot of lessons learned, and over the last 2 years, we have really gathered a lot of data.”

The data being gathered are unique—their goal is to create a clear picture of HIV/AIDS care in the United States. “We want to identify where the holes are, discover what the unmet needs are, provide data to assist groups making decisions on how to allocate funds for prevention and care, and inform physicians about what patients are saying about their care,” said Morgan.

Currently, 23 project areas are conducting data collection activities in the new cycle, which started June 1, 2009. There were originally 26 project areas, but because of limited funds, not all areas could be funded again.

The project areas selected are estimated to include over 80% of the total HIV/AIDS cases in the United States. The annual sample of facilities includes 25–50 facilities from each project area representing small, medium, and large HIV care facilities; and a sample of about 400 patients from each project area is selected from participating health care facilities. Participants must be at least 18 years old, diagnosed with HIV, and receiving care.

Because MMP’s estimates will be nationally representative of HIV-positive people in care, information gathered may be used by prevention planning groups, policy leaders, health care providers, and people living with HIV/AIDS to highlight disparities in care and services, identify unmet needs, and ultimately lead to improvements in the medical care of people with HIV/AIDS.

A quarterly newsletter provides updates on MMP, profiles of members of MMP’s provider and community advisory boards, and features on MMP’s collaborating organizations. The September/ October issue spotlights Stephen Bailous, vice president for community affairs of the National Association of People with AIDS (NAPWA). NAPWA has collaborated with MMP from the beginning of the project by making sure that their constituents understand the importance of this project and that they participate actively. Read the newsletter.

Learn more about MMP.

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DHAP HIV Prevention Strategic Planning Update

DHAP is committed to fulfilling its mission of preventing HIV infection and reducing the incidence of HIV-related illness and death. The division has begun steps toward developing a new HIV prevention strategic plan that will replace its existing strategic plan.

HIV prevention is a critical component of a National HIV/AIDS Strategy, and the division is hopeful that its new strategic plan will inform the prevention component of the National Strategy. The new 10-year plan will start in 2010. The focus will be on priority populations that are most affected by the HIV/AIDS epidemic, and there will be strategies to effectively allocate resources.

We have completed the first step in the multi-step process—an external peer review that was conducted in April and involved more than 70 experts from universities, health departments, community-based organizations, and other groups. The external peer review allowed us to receive extensive input that is serving as the foundation for the division’s strategic planning process.

DHAP received the final recommendations from the peer review process in October and has developed a response to the reviewers’ recommendations. Read the external peer review final report and an executive summary of the division’s responses to its findings and recommendations. A complete list of panel members and their affiliations is also available at the site.

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CDC Expands Efforts to Dispel Rumors and Myths about HIV and AIDS

When the United States was beginning to confront HIV in the 1980s, not much was known about the virus or AIDS. This lack of knowledge created the perfect breeding ground for rumors and myths. Two of the most persistent rumors are that HIV can be caught from a toilet seat or can be transmitted by mosquitoes.

Some myths, such as inaccurate beliefs about HIV transmission through saliva, can have devastating effects on people living with HIV who are wrongly accused of endangering the health of others. For most of us working in public health, those rumors were disproven so long ago that we rarely think about them. However, some people are just hearing these rumors for the first time and need the tools to distinguish what is a real threat—unprotected sex, for example—from a myth.

CDC is committed to ensuring the timeliness and veracity of HIV prevention information and dispelling myths and rumors about HIV and AIDS. The agency and the division are continually reexamining the information that is being circulated and myths that are being perpetuated. Providing basic information about HIV, including HIV transmission, to the general public—and making clear what constitutes a legitimate risk versus what is simply an unfounded fear—are fundamental to our HIV prevention efforts. Rumors, myths, and hoaxes not only hinder an individual’s efforts to stay healthy, they can also contribute to stigma and discrimination related to HIV testing and people living with HIV/AIDS. These fears can also undermine scientific approaches to public health and may deter people from accessing testing and prevention interventions.

Therefore, in upcoming months, you’ll see expanded actions by the division to address myths and misperceptions, including an expanded “Rumors, Myths, and Hoaxes” section of CDC’s Web site that will include a podcast on research about misinformation that contributes to discrimination and stigma; an updated and expanded series of fact sheets with the first one dedicated to HIV transmission; and key facts for staff and state health departments.

CDC will widely market these materials. However, everyone—staff, public health partners, health care providers, and others—can play a role in this important effort to dispel rumors, myths, and hoaxes. By doing so we can all work to eliminate stigma about living with HIV or AIDS and about HIV testing, and address barriers that discriminate against people who are living with HIV or AIDS.

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Interactive Internet Tool Explains HIV Incidence Data

In response to feedback from partners who expressed a desire to have CDC data in a more accessible, visual manner, DHAP has created The State of the HIV/AIDS Epidemic: HIV Incidence in the United States. This interactive Flash module portrays HIV incidence data from 2006, the most recent year for which those data are available.

This module allows the user to visualize HIV incidence by transmission category as well as by race/ethnicity, and to overlay those two categories to gain a clearer picture of the groups most affected by HIV in the United States. The user can create custom presentations of the data or use the module, with or without the optional narration, as a stand-alone presentation.

The module can be accessed from the incidence surveillance page of DHAP’s Web site. Because The State of the HIV/AIDS Epidemic: HIV Incidence in the United States is the first module of this type that DHAP has produced, we are soliciting feedback on its usefulness. Please send comments on this module, as well as suggestions for future topics, to hivpartnercomments@cdc.gov.

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DHAP Welcomes Input on HIV Objectives for Healthy People 2020

For three decades, Healthy People has provided a set of national 10-year health promotion and disease prevention objectives aimed at improving the health of all Americans.

In preparation for the launch of Healthy People 2020, DHAP recently completed revisions of the HIV objectives. These draft objectives were chosen from among DHAP’s national results monitoring and evaluation indicators and are drawn primarily from key DHAP data systems. There is now an open invitation to comment on these draft objectives during a public comment period which ends December 31, 2009.

Visit Healthy People 2020: The Road Ahead to

• View proposed draft objectives
• Comment on the proposed objectives
• Comment on all the topic areas
• Suggest additional objectives
• Suggest topic areas you feel are missing from the draft set

Healthy People 2020 will reflect assessments of major determinants of health and wellness, changing public health priorities, and emerging issues related to our nation’s health preparedness and disease prevention.

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President Obama Eliminates HIV Entry Ban

On October 30, President Barack Obama, in conjunction with reauthorizing the Ryan White HIV/AIDS Treatment Extension Act of 2009, announced that his administration is lifting the travel ban on entry into the United States for people living with HIV/AIDS.

“It’s a step that will encourage people to get tested and get treatment, it’s a step that will keep families together, and it’s a step that will save lives,” the President said.

Starting in January 2010, persons who are HIV-positive and are not U.S. citizens will be able to enter the United States. According to Jeffrey Crowley, director of the National Office of AIDS Policy, removing the entry ban “is a major step in ending the stigma associated with HIV.”

Since 1987, HIV-positive travelers and immigrants have been banned from entering or traveling through the United States without a special waiver. Secretary of State Hillary Clinton announced on the eve of World AIDS Day that as a result of the travel ban being lifted, the International AIDS Conference will be held in Washington, DC, in 2012. The conference was last held in the United States in 1990 in San Francisco.

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DHAP to Begin New Study for HIV-Discordant Couples in Asembo, Kenya

DHAP, in collaboration with the Kenya Medical Research Institute (KEMRI), will soon begin a study involving HIV-discordant couples. The study seeks to determine whether antiretroviral therapy (ART) can prevent the sexual transmission of HIV in discordant couples. An HIV-discordant couple is a couple where one partner is HIV-infected and the other is not HIV-infected.

Because there is a need to find new and better ways to prevent HIV transmission from an HIV-infected partner to an HIV-uninfected partner, the National Institutes of Health (NIH) Division of AIDS (DAIDS) is sponsoring this international HIV study that is being carried out in multiple sites in Africa, Asia, South America, and the United States. Through its HIV Prevention Trials Network (HPTN) branch, KEMRI/CDC will host the only site in Kenya.

The effort in Kenya will be led by Lisa Mills, incoming branch chief for the HIV Research Branch at the field research station in Kisumu. Dr. Mills has extensive international experience with HIV-related research and care, including 5 years spent as an investigator with the Anti-Retroviral Cohort Study of Rakai Health Sciences Program and the NIH International Center for Excellence in Research in Uganda.

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Upcoming Events and Meetings

2010 Black Gay Research Group (BGRG) Summit: “Reclaiming Our Place: Emerging Research and Dialogues on the Lives of Black Gay Men,” Atlanta, GA, January 20, 2010.

2010 National African American MSM Leadership Conference on HIV/AIDS and Other Health Disparities: “Stepping Forward, United,” Atlanta, GA, January 21–24, 2010.

National Black HIV/AIDS Awareness Day, February 7, 2010.

17th Conference on Retroviruses and Opportunistic Infections (CROI 2010), San Francisco, CA, February 16–19, 2010.

National Women and Girls HIV/AIDS Awareness Day, March 10, 2010.

XVIII International AIDS Conference (AIDS 2010): “Rights Here, Right Now,” Vienna, Austria, July 18–23, 2010.

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New Publications, Web Sites, and Other Materials

Peer-Reviewed Journal Articles

DHAP researchers have recently published a variety of articles covering a range of topics, including postnatal HIV transmission, gastroenteritis in children in Malawi, correlates of forced sex among men who have sex with men (MSM) in Thailand, integration of reproductive health into HIV care for women in the United States, and pandemic influenza. When available, links to abstracts in PubMed or to full articles in open-access journals are provided.

In “Multisite Comparison of Anti-Human Immunodeficiency Virus Microbicide Activity in Explant Assays Using a Novel Endpoint Analysis,” published in the November issue of the Journal of Clinical Microbiology (2009 Nov;47(11): 3530–3539), Patricia Guenthner of DHAP’s Laboratory Branch and colleagues evaluated a novel soft-endpoint method to provide a single, objective measurement of virus growth when comparing virus growth or the anti-HIV-1 efficacies of candidate microbicides in tissue explants. They found that application of the soft-endpoint method reduces the inherent variability in comparisons of preclinical assays used for microbicide development. Read the abstract.

In “Integrating Reproductive Health into HIV Care of Women in the United States: It is Time,” published in the September issue of AIDS (2009; Sep 10;23(14):1928–1930), Margaret Lampe of DHAP’s Epidemiology Branch (EB) and colleagues assert that “Providing comprehensive well-woman care for the HIV-infected woman within the broad scope of her lifespan is not only necessary to fully implement perinatal HIV prevention goals, but also to embrace the longer and fuller lives that HIV-infected individuals are now leading. It is time we caught up with our success.”

In “Pandemic Influenza: Implications for Programs Controlling for HIV Infection, Tuberculosis, and Chronic Viral Hepatitis,” published in a special edition of the American Journal of Public Health (2009 Oct; 99 Suppl 2:S333–S339), DHAP’s James Heffelfinger of the Behavioral and Clinical Surveillance Branch; Pragna Patel, Phil Peters, and John Brooks, all of EB; Lauretta Pinckney of the Program Evaluation Branch (PEB); Drew Voetsch of the Global AIDS Program; NCHHSTP coauthors from the Office of the Director (Hazel Dean), Division of Tuberculosis Elimination, Division of Viral Hepatitis, and Division of STD Prevention; another CDC coauthor; and coauthors from state and local health departments reviewed pandemic influenza preparedness for persons living with HIV infection, tuberculosis, and viral hepatitis. Read the abstract.

In “Emotional and Behavioral Problems and Mental Health Service Utilization of Youth Living with HIV Acquired Perinatally or Later in Life,” published in the November issue of AIDS Care (2009;21(11):1447–1454), Linda Koenig of DHAP’s Prevention Research Branch, Renee Stein of PEB, and colleagues found that more than a quarter of adolescents with clinical levels of psychological symptoms had not received mental health services, and that youth whose sexual orientation was self-identified as bi-sexual or questioning had the highest levels of emotional/ behavioral problems. No differences were found based on perinatal or non-perinatal infection status. Read the abstract.

In “HIV Testing Outside of the Study Among Men Who Have Sex With Men Participating in an HIV Vaccine Efficacy Trial,” published in JAIDS, the Journal of Acquired Immune Deficiency Syndromes (2009;52(2):294–298), DHAP’s Deborah Gust and Robert Chen of EB, Ryan Wiegand of the Quantitative Sciences and Data Management Branch (QSDMB), and colleagues found that 17% of MSM reported being tested for HIV outside of the study, despite being given instructions not to be tested outside of the study. Read the abstract.

In “Complete Protection from Repeated Vaginal SHIV Exposures in Macaques by a Topical Gel Containing Tenofovir Alone or with Emtricitabine,” published in the October issue of the Journal of Virology (2009;83(20):10358–10365), DHAP’s Urvi Parikh, Charles Dobard, Sunita Sharma, Mianer Cong, Hongwei Jia, Amy Martin, Chou-Pong Pau, Patricia Guenthner, James Smith, Elle Kersh, J. Gerardo Garcia-Lerma, Ron Otten, and Walid Heneine, all of the Laboratory Branch; Debra Hanson of QSDMB; and colleagues found that single drugs with durable antiviral activity can provide highly effective topical prophylaxis and overcome the need for noncoital use or for drug combinations which are more complex and costly to formulate and approve. Read the abstract.

In “Postnatal HIV-1 Transmission after Cessation of Infant Extended Antiretroviral Prophylaxis and Effect of Maternal Highly Active Antiretroviral Therapy,” published in the November issue of The Journal of Infectious Diseases (2009 Nov 15;200(10):1490–1497), Michael Thigpen of DHAP’s EB and colleagues from the United States and Malawi assessed the association between postnatal HIV-1 transmission and maternal highly active antiretroviral therapy (HAART) after infant extended antiretroviral prophylaxis. They concluded that postnatal HIV transmission continues after cessation of infant prophylaxis. HAART-eligible women should start treatment early for their own health and to reduce postnatal HIV transmission to their infants. Read the abstract.

In “Trends in Multidrug Treatment Failure and Subsequent Mortality among Antiretroviral Therapy–Experienced Patients with HIV infection in North America,” published in the November issue of Clinical Infectious Diseases (2009;49:1582–1590), John Brooks of EB and colleagues with the NA-ACCORD found that although the effectiveness of combination antiretroviral therapy continues to improve—even among those patients who experienced failure of an initial regimen—among persons who experience virologic failure of at least two distinct regimens, there has been no substantial improvement in survival after the second failure. The HIV Outpatient Study contributes data to NA-ACCORD, a multi-cohort project sponsored by the National Institutes of Health. Read the abstract.

In “Frequency of Gastroenteritis and Gastroenteritis-Associated Mortality with Early Weaning in HIV-1–Uninfected Children Born to HIV-Infected Women in Malawi,” published online October 20, 2009, in JAIDS, Michael Thigpen of DHAP’s EB and colleagues found early weaning was associated with increased risk of severe gastroenteritis and gastroenteritis-related mortality among HIV-exposed infants. They conclude that strategies are urgently needed which allow longer breastfeeding while reducing the risk of HIV breast milk transmission in resource-limited settings. Read the abstract.

In “Correlates of Forced Sex Among Populations of Men Who Have Sex with Men in Thailand,” published in October online in Archives of Sexual Behavior (2009 Oct 15 [Epub ahead of print]), DHAP’s Frits van Griensven of EB and other CDC and Thai colleagues assessed the prevalence of forced sex and correlates among populations of MSM (this includes general MSM, male sex workers, and male-to-female transgender persons) in Thailand using a community-based sample. Read the abstract.

In “Breastfeeding, Mother-to-Child HIV Transmission, and Mortality Among Infants Born to HIV-Infected Women on Highly Active Retroviral Therapy in Rural Uganda,” published in the October 2009 JAIDS (published ahead of print), DHAP Director Jonathan Mermin and colleagues conclude that in resource-constrained settings, HIV-infected pregnant women should be prioritized for HAART eligibility assessment and encouraged to breastfeed their infants for at least 6 months. Read the abstract.

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Journal Supplements Highlight Important Research

CDC Supplement about Hispanics/Latinos and HIV/AIDS Published in AIDS Education and Prevention

The articles in “Hispanics/Latinos and HIV/AIDS: Epidemiologic, Behavioral and Ecological Influences of Risk and Best Practices for Prevention” highlight CDC’s commitment to addressing the epidemiologic, socio-ecologic, and behavioral influences of risk, and to increasing awareness of best practices for HIV prevention among vulnerable hispanic/Latino communities. Guest editors were JoAna M. Stallworth of the Capacity Building Branch (CBB), Jeffrey H. Herbst of the Prevention Research Branch, and Maria E. Alvarez of CBB, all of DHAP; Raúl Romaguera, formerly of DHAP and now with the Division of STD Prevention; Hazel Dean of the NCHHSTP Office of the Director; and Hortensia Amaro from Bouvé College of Health Sciences, Northeastern University.

In addition to the foreword, introduction, and summary of comments and recommendations from a CDC Hispanic/Latino consultation, the supplement’s 13 articles cover topics in surveillance and epidemiology, socio-ecological determinants of HIV risk, behavioral interventions, and capacity building. Download the supplement.

CDC Supplement in AJOG Is Second Most Cited Obstetrics and Gynecology Issue

A CDC-sponsored supplement in the September 2007 issue of the American Journal of Obstetrics and Gynecology (AJOG) has been cited 78 times in 2008 (as tracked by Scopus). The ratio of 2008 citations to 2006–2007 citable items is 2.820 for AJOG, and an impressive 4.333 for the supplement.

The supplement, titled “Achievements, Issues, and Challenges: Prevention of Mother-to-Child HIV Transmission in the United States and in Resource-Limited Settings,” demonstrates collaboration among DHAP branches as well as other CDC programs such as the Division of Reproductive Health (DRH) and the Global AIDS Program (GAP).

CDC editors for the project were Margaret Lampe (Epidemiology Branch, DHAP), Denise Jamieson (DRH), Nathan Shaffer (GAP), and Martha Rogers (formerly with DHAP and now director, Center for Child Well-Being, The Task Force for Global Health). DHAP’s Judy Griffith (Prevention Communication Branch) served as the communications project manager, and Alpa Patel-Larson (Program Evaluation Branch) was the project coordinator on behalf of DHAP’s Perinatal Executive Committee.

View the supplement online.

To view recent MMWR articles with HIV/AIDS content, surveillance reports, fact sheets, slide sets, and other new publications, check out the “What’s New?” section on the DHAP Internet.

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Welcome to Act Against AIDS Update, a new section of DHAP News that provides the latest information on CDC’s Act Against AIDS (AAA) campaign and updates on the various phases within the campaign.

Launched in April 2009, AAA is a 5-year, multifaceted national communication campaign designed to combat complacency about the HIV/AIDS crisis in the United States, refocus national attention on the domestic epidemic, and reduce HIV incidence in the United States.

Although Act Against AIDS is in its early phases, it has already created more than 275 million audience impressions through its transit, on-line, radio, television, print, and outdoor advertisements and announcements, including a full-color Jumbotron advertisement in Times Square that was secured through a partnership with the National Medical Association and that created at least 84 million audience impressions. The Web site home page has had more than 100,000 views, with 15,000 hits the first week and more than 18,000 hits on World AIDS Day this year.

The campaign is being planned and released in phases, many of which are running concurrently. Each phase of the campaign has its own unique objectives and target audiences and utilizes mass media and direct-to-consumer communication channels to deliver important HIV prevention messages. The campaign focuses on reducing the risk of infection among the hardest-hit populations: African American men and women, men who have sex with men (MSM) of all races, Latinos, and other communities disproportionately affected.

Current campaign phases, geared to different target audiences, are 9½ Minutes; Prevention IS Care; One Test. Two Lives.; HIV Screening. Standard Care.; Take Charge. Take the Test.; Greater Than AIDS; an HIV testing phase for black MSM; and the upcoming i know. Over the course of the multi-year campaign, additional phases will be launched for other populations at increased risk.

For more information, visit the campaign Web site.

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9½ Minutes Public Service Announcement (PSA) Sends Powerful Message

The 9½ Minutes PSA, developed for the first phase of the campaign, is currently being distributed to national broadcast media as well as local media, cable stations, and Spanish networks in top markets across the United States. The PSA carries the simple and direct message: Right here in the United States, every 9½ minutes, someone’s brother, mother, sister, father, or neighbor is infected with HIV. The PSA is available in English and Spanish and includes the voices of Dennis Haysbert, an American film and television actor, and Eduardo Blancas, an analyst and commentator for FOX en Espanol.

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Web Banner Ads for BMSM HIV Testing Phase Released

Campaign phases focused on African Americans, who by far bear the greatest burden of HIV in the United States, are under way. An initial series of online banner advertisements for the Black Men Who Have Sex with Men (BMSM) HIV testing phase launched in September. The ads were developed in conjunction with a work group of 19 BMSM experts from across the nation and tested with the target audience. In addition to the initial banner ads, CDC is working with its expert work group to develop a broader, more comprehensive social marketing effort to reach BMSM through this phase, which focuses on the importance of HIV testing in this population.

In the first two weeks of preliminary testing, the online banner ads featured on social networking Web sites—BGC Live, Downelink, and Men4Now—had an average .083 click-through rate, which is well above average. Click-through rates between .02 and .08 are considered good. These rates, which are measures of online advertising, are obtained by dividing the number of users who clicked on an ad (clicks) by the number of times the ad was delivered/shown on the Web page (impressions).

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i know Focuses on African American Young Adults

i know, an upcoming phase of the Act Against AIDS campaign, focuses on countering myths and misconceptions about HIV and AIDS among African American young adults. As a part of the formative research for this campaign phase, CDC’s Partnerships Team in the Prevention Communication Branch is collaborating with the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC) in an effort to garner insight and input from business partners regarding i know strategies and tactics. During a recent “think tank” session hosted by GBC, representatives from Young and Rubicam Advertising, the National Basketball Association (NBA), Black Entertainment Television (BET), and others lent their marketing and advertising expertise in the form of recommendations intended to help reach the target audience. Many of the insights obtained during this session will be coupled with CDC research and will inform messages, creative materials, and events slated for 2010.

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Take Charge. Take the Test. Coming to Health Departments in 2010

Take Charge. Take the Test., a phase of the AAA campaign designed to increase HIV testing among African American women, has already been successfully pilot-tested in two cities and will be available to health departments in 2010. The roll-out will include scalable implementation levels that can complement local health department efforts to educate and empower African American women to take charge of their lives and get tested for HIV. For more information, contact Jennie Johnston.

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Black AIDS Media Partnership Launches Greater Than AIDS

CDC has developed the Act Against AIDS Media Initiative, which is designed to leverage a variety of media partners to support HIV prevention efforts. The first of these partnerships is the Black AIDS Media Partnership (BAMP), convened by CDC in association with the Kaiser Family Foundation and their media partners. BAMP has recently launched the initiative, a coordinated effort to engage leaders in black media to support prevention efforts to reach black Americans with life-saving information about HIV/AIDS, to confront the stigma surrounding the disease, and to unite and engage the black community in responding to HIV/AIDS. The campaign includes public service advertising across an array of media platforms, special programming and editorial content, a dedicated Web site, and a mobile component. For more information visit Greater Than AIDS.

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Bronner Brothers: A Strong Partner in Fighting the HIV/AIDS Epidemic

Partnerships—both public and private—are vitally important to the success of the Act Against AIDS campaign. Bronner Brothers, a privately held, family-owned company that includes Bronner Brothers Beauty Products, UPSCALE Magazine, and the Bronner Brothers International Beauty and Trade Shows, demonstrates a good example of the powerful role that partnerships can play in fighting the epidemic.

The company has committed to disseminating HIV/AIDS information throughout their broad client base. In UPSCALE Magazine, they have devoted editorial space to writing about the disease, as well as advertising space. The ad shown here appears in recent issues of the magazine. For the first time, they also incorporated HIV/AIDS prevention messages and testing into their 2009 Bronner Brothers International Hair Show. More than 60,000 hairstylists, exhibitors, distributors, and cosmetology students attended the show.

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