PREVENTION: Study Shows Risk Reduction Counseling Effective In High-Risk Populations
A groundbreaking study in today's Science shows that educational and counseling sessions are effective in curbing risky sexual behavior among groups at a high risk for HIV, proof that preventing the spread of the epidemic is as important as figuring out how to treat it. The Philadelphia Inquirer reports that the study of 3,706 low-income African Americans and Hispanics in 37 inner-city health clinics provides the "first hard evidence" that initiatives aimed at "chang[ing] people's behavior -- as opposed to medical interventions such as drugs or vaccines -- have an important role to play in stopping the spread of HIV" (Collins, 6/19). "Reducing high-risk behaviors is still the best way to prevent HIV infections," said Dr. Steven Hyman, director of the National Institute of Mental Health, which funded the study. "There has been a stigma ... about the ability to reach this disadvantaged population. We have identified an effective strategy that could be adopted by public health and community organizations all across America" (Maugh II, Los Angeles Times, 6/19). The advocacy group AIDS Action said the study's findings are "a wake-up call for a new era of prevention." Daniel Zingale, the group's executive director, called prevention a "virtual vaccine" that could curb the epidemic, noting that the "national leadership" should be behind prevention efforts just as they would back a real vaccine. "Until there's a cure, the most immediate breakthroughs in fighting HIV will come through treating prevention like the vaccine we so desperately crave," he said (AIDS Action release, 6/18).
Study participants attended seven two-hour small-group sessions featuring discussions about AIDS and sexual behavior, role-playing activities, instruction in proper condom use and videos about safer sex, while a control group received one hour-long AIDS education session, the Washington Times reports. During the year after the training program, subjects were periodically asked to report on their behavior. Participants in the intensive counseling sessions "reported significantly fewer unprotected sexual acts, had higher levels of condom use and were more likely to use condoms consistently" (Larson, 6/19). Researchers also found that men in the intervention project "were only half as likely to contract gonorrhea" -- considered a reliable marker of whether people are practicing risky sexual behavior -- than those who did not attend the sessions, according Rutgers University's Ann O'Leary, who conducted the study (Groves, Bergen Record, 6/19).
Researchers called prevention programs a "cost-effective" way to deal with the HIV epidemic, the AP/Contra Costa Times reports (Recer, 6/19). Hyman said the intervention program used in the NIMH study cost about $278 per participant -- "about the same as the cost of one week of treatment for an HIV-infected person with protease inhibitors," the Washington Post reports. Funding for AIDS research and treatment continues to increase, but federal funds for prevention have remained steady. "When it comes to prevention, the watchword is, give as little as possible and expect a lot," said University of California-San Francisco's Thomas Coates. "That's a misguided way to look at prevention ... We know a vaccine is a long way off. We know the treatments are imperfect and are going to be harder and harder to deliver. Prevention is still where it's at" (Okie, 6/19) And "state and local governments have spotty records when it comes to funding intervention," the Asbury Park Press reports. Rutgers' O'Leary said she hopes prevention techniques will be used, but added that most "health and community organizations are severely underfunded," which prevents public officials from implementing intervention programs in the areas that need them most. "Because funds are limited we have had to place prevention projects in the cities with the highest incidence," said Steven Saunders of the New Jersey health department's AIDS prevention division. "We have those covered, but people in cities with lower incidence rates need something as well" (McEnery, 6/19).
Politics As Usual
The Atlanta Journal-Constitution reports that "politics sometimes defeats scientific reason when it comes to American AIDS prevention policies, notably the federal government's support of abstinence-only education and refusal to finance needle-exchange programs." The National Academy of Sciences' Karen Hein said the rates of HIV, STDs and unintended pregnancy are higher in the United States than in other developed nations because of the "widespread 'reluctance to use scientific findings as a basis for policy because of the perceived political consequences" (McKenna/Kim, 6/19). "It did take a while to get the science in place. Now ... it's there," Hein said. "Now, perhaps the focus ought to be on policy and politics" (Washington Post, 6/19).