Transcript Can China Avoid making everyone elses` mistakes

CDC-NIMH Conference
Closing Meditations
Thomas J. Coates PhD
Professor of Medicine
Director, AIDS Research Institute
University of California
San Francisco CA USA
• Risk
behavior
and
HIV
Risk behavior
and
HIV
incidence
increases
incidence
increases
Challenge #1
Can China Avoid Making Everyone Else’s
Mistakes

Keep prevalence low?

Not allow treatment to reduce
prevention efforts

Convince people that HIV is still not
a good disease to have

Make sure that everyone gets
treatment
1984
838 AIDS Cases/491dead
1989
7569 AIDS Cases/5589 dead
1994
20,333 AIDS Cases/14,349 dead
27982 cases
18957 deaths
Rectal gonorrhea among MSM
250
200
150
100
Preliminary: Continued increase into 2002
50
0
1997
1998
1999
Source: City-wide STD case surveillance.
2000
2001
Early syphilis among MSM
140
120
Preliminary: Continued increase into 2002
100
80
60
40
20
0
1997
1998
1999
2000
2001
Source: City-wide STD case surveillance. Note: figures updated from abstract.
New HIV Infections, 1997 vs. 2001
120
100
117
93
80
60
44
40
20
12
0
Het IDU
Het
1
0
Children
1
0
Blood
New HIV Infections, 1997 vs. 2001
800
748
700
600
500
400
300
283
200
100
64
142
87
0
MSM
MSM-IDU
Transgender
Other prevention technologies

Female-controlled methods
including diaphragm

Circumcision

New VCT Technologies

Appropriate STI control
e.g., for viral infections

Penile wipes
Public Health Decisions

Evidence-based

Values-based

Security-based

Constituency-based
Injection Drug Users

Opportunities to do study the impact of harm
reduction strategies

Opportunities to prevent vertical transmission
Other Challenges

Other prevention technologies

Populations

Topics

Methods

Issues
Voluntary Counseling and
Testing
 Preventive strategy vs Intro to treatment vs
surveillance
 Training and quality assurance for counseling
 New testing technologies for specific
populations
Populations

Infected individuals--positive
prevention

Pregnant women

MSM and male CSWs

Military

Prisons

The poor, especially the urban poor
Methods

Behavioral reports

Multidisciplinary strategies

Bringing in economics, law, policy
Topics

Evidence-based policy research

Substance abuse and mental health

Changing sexual norms

Economic disparities
Probability of Survival After AIDS
Diagnosis by Race, San Francisco,
1993-1995
100%
Proportion Surviving
90%
80%
70%
60%
50%
40%
White
African American
Latino
30%
20%
10%
0%
0
6
12
18
24
30 36
42
48
54 60
66
Months
72
78 84
90
96 102 108 114
Probability of Survival After AIDS
Diagnosis by Race, San Francisco,
1996-1999
100%
Proportion Surviving
90%
80%
70%
60%
White
African American
Latino
50%
40%
30%
20%
10%
0%
0
6
12
18
24
30
36
42
Months
48
54
60
66
72
78
HAART use by neighborhood,
San Francisco, 2001
5 year survival by neighborhood,
San Francisco, 2001
Economic Development and Cultural
Change

Economic development leads to

Decreased age of first intercourse

Increased access to the internet and sexually
explicit materials

Increased risk behavior

Commercial sex

More mobility

Less access to health care
Surveillance

National and local

Multidimensional and comprehensive

Regular intervals
Stigma

How stigma impacts various groups
 Attitudes towards persons with HIV and how this
impacts availability of and access to services
 Combined stigmas: drug use, homosexuality, poverty,
HIV, commercial sex
 Access to treatment and prevention services
 Legislation and policy and its impact on stigma
 Impact of treatment on stigma
Stigma
 Community, mass media, and other social
interventions
 Intervene with perpetrators of stigma
 Intervene with public health officials and policy
makers
 School-based interventions to reduce stigma
 Programs for parents
Technology Transfer
 Efficient and effective
 Quick
 Adaptable
 With high quality
 No need to “reinvent the wheel”
Blood Safety

Ongoing study

Motivations for donation

Motivations and strategies for self-deferral
Ari.ucsf.edu
www.caps.ucsf.edu
www.ucsf.edu and then go to web
sites and then to AIDS Research
Institute