New CDC Funding Emphasizes Accountability

Five-year program, with $49 million up front, establishes HIV prevention measures

The federal Centers for Disease Control and Prevention (DCD) has announced $49 million in HIV prevention grants that require grantees to prove that their efforts are effective and focus more on doing prevention among people who are already infected with the virus.

“The announcement included some specific items that are called program performance indicators,” said Dr. Harold W. Jaffe, director of CDC’s National Center for HIV, STD and TB Prevention. “They attempt to set goals.”

The CDC expects to fund roughly 160 grants ranging in amounts from $100,000 to $500,000, according to the December 3 announcement. The grants will run for five years, but the $49 million represents only the first year’s funding.

The announcement also includes 13 indicators, or measures, of whether or not the funded program is doing what it claims to do, that applicants must incorporate in their programs.

“For example, let’s say one of your activities is outreach and testing,” Jaffe said. “One indicator might be the percent of newly-identified positive tests that were returned to a client.”

Traditionally, such government grants measured the grantee’s performance in units of service such as how many people participated in a counseling program. While that could still be one indicator, the CDC also wants to know how many contacts were required to get one person into counseling and whether that individual complete the counseling.

“There is more of an expectation for accountability in HIV prevention, to say we really need to see what you’re accomplishing,” Jaffe said.

The funded groups will use their first year’s dollars to establish a baseline for their activities, set annual targets, and overall targets for the five years. The first-year awards will be larger so groups can cover start up costs. Groups that do not meet their targets face a cut in or the elimination of their grant.

The grants are also designed to fund so-called prevention for positives or programs that get HIV-infected individuals to alter their behavior so they do not transmit the virus to others. Such efforts are distinct from prevention for HIV-negative people, which is known as primary prevention.

“In the past most of what we have funded was for primary prevention,” Jaffe said. “We are going beyond that. We are asking organizations to either make referrals to HIV counseling and testing services or to work with infected people.”

Republicans on Capitol Hill have been pointing to rising HIV infections among gay and bisexual men and questioning the efficacy of HIV prevention programs that target that population. Whether the new measures will silence those complaints depends on the results.

“With the failure to reduce HIV rates over the past decade, new prevention approaches are clearly needed,” wrote Roland Foster, a Congressional staffer, in an e-mail response. “We applaud the goals and strategies of the new CDC initiative and are optimistic. We will, however, expect outcomes, including actual decreases in HIV/STD rates and reductions in risk behaviors, to demonstrate that the program is effective. It is equally important that those newly-diagnosed are ensured access to treatment and ongoing prevention services.”

Foster works on the House Subcommittee on Criminal Justice, Drug Policy and Human Resources chaired by Mark Souder, an Indiana Republican. Souder has been one of the leading critics of the efficacy of HIV prevention programs and Foster has often been his spokesperson.

Leon James, a staffer at People of Color in Crisis who runs that group’s Many Men, Many Voices HIV prevention program, welcomed the CDC’s new measures.

“I think that people should have empirical data saying that what they are doing is effective,” he said. “They are asking that you show that what you are doing is what you say you are doing and they are asking that you connect that to a well thought out plan of action.”

In a December 3 conference call announcing the grants, Many Men, Many Voices was cited as a program that other AIDS groups could use as a model for their own efforts.

Mark McLaurin, associate director for prevention policy at the Gay Men’s Health Crisis (GMHC), said most AIDS groups were generally positive in their response to the CDC announcement.

“While there is some trepidation, there is also some kind of looking forward to being able to demonstrate that what they are doing works,” he said.

GMHC is a member of the Prevention Action Network, a coalition of more than 300 AIDS groups including roughly 190 that get grants directly from the CDC.

McLaurin said that AIDS groups have not had an effective response to those who criticize prevention efforts. The new CDC program might be that answer.

“There is no way to evaluate efficacy of prevention programs and quite frankly in the prevention advocacy community we haven’t had a good answer to that question,” McLaurin said. “While this represents another hill to climb, we welcome this step. It represents the first opportunity that we have to demonstrate that prevention does indeed work.”

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