Federal Spending on HIV Prevention to Shift Course

Federal spending on safe-sex programs to prevent HIV among uninfected people will be curtailed next year in favor of a new campaign to stop the spread of the virus by those who already have it, AIDS prevention groups learned Thursday.

In a conference call with more than a dozen prevention advocates, a federal health official said the government plans to invest most heavily in initiatives that offer HIV testing and counseling to infected people, several participants told The Times.

That would mark a substantial shift in priorities. At stake is some $90 million that the federal government provides to community groups for HIV prevention each year, advocates said.

“There ain’t going to be any more safe-sex workshops,” said Terje Anderson, executive director of the National Assn. of People with AIDS, who listened to the call from Dr. Rob Janssen, director of HIV prevention at the national Centers for Disease Control and Prevention. “There ain’t going to be any more public attitude campaigns around this.”

Janssen said the changes would be completed in three weeks to six weeks and would likely take effect in July 2004, call participants said.

Janssen could not be reached by The Times for comment. A CDC spokesman, Tom Skinner, said the agency hasn’t yet determined which programs would be ineligible for federal funding.

But Skinner confirmed that the agency is going to give funding priority to programs that expand HIV testing and provide individualized counseling to those who test positive and their sexual partners. These goals were outlined Thursday in the CDC’s publication, Morbidity and Mortality Weekly Report.

The new strategy is aimed particularly at the more than 200,000 people who have HIV but do not know it and may be passing it to others unwittingly.

The conference call with prevention groups came one day after CDC Director Dr. Julie L. Gerberding told The Times that efforts aimed at high-risk uninfected people appear to be stalled, with the number of new HIV infections hovering at about 40,000 per year for the last decade.

Leading AIDS groups criticized what they described as a sudden shift in national health policy.

Ronald Johnson, associate executive director of Gay Men’s Health Crisis in New York, said he is worried that the CDC is making a “significant movement” away from programs aimed at HIV-negative people “to the point of not even funding such programs.”

Daniel Montoya, director of government affairs for AIDS Project Los Angeles, agreed.

“I think it is shortsighted in some ways,” Montoya said. “Unless you are doing comprehensive prevention, in terms of looking at people who are at risk and not just look at those who are already infected, we may have another epidemic on our hands 10 years down the road.”

Some prevention advocates said the CDC’s strategy is aimed at an elusive group of people who, even if they are identified, the government isn’t offering any extra money to treat them. Many of the people who don’t know about their infection are believed to be minorities with little access to health care or knowledge that they are at risk.

Anderson of the National Assn. of People with AIDS said he believes the CDC may be using the guise of expanded testing as a way to dodge the criticism it has received from conservative politicians about safe-sex programs.

“This gets rid of the lightning rod,” Anderson said. “It’s just a backdoor way of defunding some of these interventions that have been so controversial.”

Safe-sex campaigns have become increasingly controversial since President Bush took office, because of their sexually explicit content. The government has launched a nationwide series of audits on HIV prevention groups to see if they are properly spending federal dollars and adhering to regulations.

One of the most publicized audits was aimed at the Stop AIDS Project, based in San Francisco, which held workshops called “Booty Call” and “Great Sex.” After initially saying the group may have violated federal guidelines, inspectors concluded this year that the organization was complying.