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CDC-NIMH Conference Closing Meditations Thomas J. Coates PhD Professor of Medicine Director, AIDS Research Institute Uni PowerPoint Presentation
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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 incidence increases. Risk behavior and HIV incidence increases.

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slide1

CDC-NIMH Conference

Closing Meditations

Thomas J. Coates PhD

Professor of Medicine

Director, AIDS Research Institute

University of California

San Francisco CA USA

slide2

Risk behavior and HIV

  • incidence increases

Risk behavior and HIV

incidence increases

challenge 1 can china avoid making everyone else s mistakes
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
slide5

1984

838 AIDS Cases/491dead

slide6

1989

7569 AIDS Cases/5589 dead

slide7

1994

20,333 AIDS Cases/14,349 dead

slide8

27982 cases

18957 deaths

rectal gonorrhea among msm
Rectal gonorrhea among MSM

Preliminary: Continued increase into 2002

Source: City-wide STD case surveillance.

early syphilis among msm
Early syphilis among MSM

Preliminary: Continued increase into 2002

Source: City-wide STD case surveillance. Note: figures updated from abstract.

other prevention technologies
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
Public Health Decisions
  • Evidence-based
  • Values-based
  • Security-based
  • Constituency-based
injection drug users
Injection Drug Users
  • Opportunities to do study the impact of harm reduction strategies
  • Opportunities to prevent vertical transmission
other challenges
Other Challenges
  • Other prevention technologies
  • Populations
  • Topics
  • Methods
  • Issues
voluntary counseling and testing
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
Populations
  • Infected individuals--positive prevention
  • Pregnant women
  • MSM and male CSWs
  • Military
  • Prisons
  • The poor, especially the urban poor
methods
Methods
  • Behavioral reports
  • Multidisciplinary strategies
  • Bringing in economics, law, policy
topics
Topics
  • Evidence-based policy research
  • Substance abuse and mental health
  • Changing sexual norms
  • Economic disparities
slide23

HAART use by neighborhood,

San Francisco, 2001

economic development and cultural change
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
Surveillance
  • National and local
  • Multidimensional and comprehensive
  • Regular intervals
stigma
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
stigma28
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
Technology Transfer
  • Efficient and effective
  • Quick
  • Adaptable
  • With high quality
  • No need to “reinvent the wheel”
blood safety
Blood Safety
  • Ongoing study
  • Motivations for donation
  • Motivations and strategies for self-deferral
slide31
Ari.ucsf.eduwww.caps.ucsf.eduwww.ucsf.edu and then go to web sites and then to AIDS Research Institute