CDC-NIMH Conference Closing Meditations Thomas J. Coates PhD Professor of Medicine

1. CDC-NIMH Conference Closing Meditations Thomas J. Coates PhD Professor of Medicine Director, AIDS Research Institute University of California San Francisco CA USA

2. Risk behavior and HIV • incidence increases Risk behavior and HIV incidence increases

4. Challenge #1Can 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

5. 1984 838 AIDS Cases/491dead

6. 1989 7569 AIDS Cases/5589 dead

7. 1994 20,333 AIDS Cases/14,349 dead

8. 27982 cases 18957 deaths

9. Rectal gonorrhea among MSM Preliminary: Continued increase into 2002 Source: City-wide STD case surveillance.

10. Early syphilis among MSM Preliminary: Continued increase into 2002 Source: City-wide STD case surveillance. Note: figures updated from abstract.

11. New HIV Infections, 1997 vs. 2001

12. New HIV Infections, 1997 vs. 2001

13. Other prevention technologies • Female-controlled methods including diaphragm • Circumcision • New VCT Technologies • Appropriate STI control e.g., for viral infections • Penile wipes

14. Public Health Decisions • Evidence-based • Values-based • Security-based • Constituency-based

15. Injection Drug Users • Opportunities to do study the impact of harm reduction strategies • Opportunities to prevent vertical transmission

16. Other Challenges • Other prevention technologies • Populations • Topics • Methods • Issues

17. Voluntary Counseling and Testing • Preventive strategy vs Intro to treatment vs surveillance • Training and quality assurance for counseling • New testing technologies for specific populations

18. Populations • Infected individuals--positive prevention • Pregnant women • MSM and male CSWs • Military • Prisons • The poor, especially the urban poor

19. Methods • Behavioral reports • Multidisciplinary strategies • Bringing in economics, law, policy

20. Topics • Evidence-based policy research • Substance abuse and mental health • Changing sexual norms • Economic disparities

21. Probability of Survival After AIDS Diagnosis by Race, San Francisco, 1993-1995

22. Probability of Survival After AIDS Diagnosis by Race, San Francisco, 1996-1999

23. HAART use by neighborhood, San Francisco, 2001

24. 5 year survival by neighborhood, San Francisco, 2001

25. 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

26. Surveillance • National and local • Multidimensional and comprehensive • Regular intervals

27. 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

28. 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

29. Technology Transfer • Efficient and effective • Quick • Adaptable • With high quality • No need to “reinvent the wheel”

30. Blood Safety • Ongoing study • Motivations for donation • Motivations and strategies for self-deferral

31. Ari.ucsf.eduwww.caps.ucsf.eduwww.ucsf.edu and then go to web sites and then to AIDS Research Institute