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Top Issues to Watch in
2010 Each year, NASTAD produces an issue of the Prevention Bulletin that reviews the past year and forecasts issues likely to have an impact on HIV/AIDS and viral hepatitis programs in the coming year. Most recently, we've focused attention on the Prevention Blueprint and the National HIV Prevention Inventory, which provides an inventory of state health department HIV prevention activities. With health reform legislation on the horizon and a struggling economy, NASTAD's annual forecast is inextricably tied to the likely impacts of these issues on public health HIV/AIDS programs. In this issue, we also ponder how these issues relate to the strategies and recommendations we've outlined in our Prevention Blueprint.
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back to top > More syndemically-oriented interventions focused on social determinants Syndemics, the science of how different social forces work together to impact risk and disease, has been gaining focus in recent years, as we recognize the incompleteness of focusing solely on the individual or even on risk behavior in the absence of the issues that mitigate or impact upon individual agency and behavior. NASTAD's July 2007 Prevention Bulletin provides a good overview of syndemics and how this may be used in prevention programs. In 2009, CDC published a report on their external consultation on addressing social determinants that impact HIV, STD, TB and viral hepatitis prevention. Look for more "buzz" on the impact and strategies related to social determinants in the coming year. back to top > Increased push toward integrated and/or holistic programs Perhaps because of a confluence of factors like budget crises happening at the same time as an increasing focus on syndemics in addressing the epidemic, there seems to be a more tangible effort to connect programs. The focus on social determinants seems to have taken center stage in the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention's approach to overall program integration. CDC is calling for more action around HIV, STD and viral hepatitis integration, with several meeting reports and other integration resources located in one central page of the CDC website. On the other hand, perhaps the reason for more overt integration can be attributed to the actions occurring at the local community-based and state levels to support integration. More and more state HIV/AIDS programs are integrated with viral hepatitis, STD, tuberculosis (TB) and programs. Over half of state adult viral hepatitis coordinators are co-located within HIV/AIDS programs. In turn, more than 60 percent of NASTAD members are also responsible for STD programs, and/or other programs like tuberculosis, refugee health, etc. As states continue to work with fewer resources, both fiscal and human, we can expect an increased push for administrative efficiencies, as well as more linked programs in 2010. back to top > Greater global-domestic synergy As NASTAD's Global Program has matured and responded to the changing priorities of the countries in which it works and those who fund our programs, it has been interesting to observe the symmetry that has emerged in the needs of these countries and those in the U. S. By the mid-part of this decade, both NASTAD global teams working with countries abroad and NASTAD's domestic technical assistance program were in the process of developing toolkits for use by new AIDS directors (click to view the domestic toolkit and the South Africa toolkit). The infrastructure and program management needs, and in particular the need for new AIDS directors to hit the ground running and rapidly scale up their leadership and management skills, has emerged as a universal theme for strong AIDS programs worldwide. Many of the countries in which NASTAD works have also focused on planning, and their experiences have informed the community-based planning efforts we have been undertaking since the early days of the epidemic in the U.S. With the likely results of the global pre-exposure prophylaxis prevention (PrEP) studies, vaccine trials and other scientific advances expected in 2010, it is clear that there is much to learn from our global experiences. Increasingly, we are working to draw more parallels with the distinct epidemics that we have in the U.S. versus those in other countries, all of which impact different populations differently, much as the impact of HIV in Africa contrasts with that in Eastern Europe, Australia and Brazil. And more importantly, with the historic lifting of the ban on immigration of people living with HIV/AIDS into the U.S., there is an opportunity to make progress in reducing the stigma of AIDS and to learn from those directly impacted by the epidemic in other countries. Indeed, as Julie Scofield's top ten list demonstrates, this means that the U.S. may be able to host the international AIDS conference for the first time ever in 2012. back to top > Increased use and sophistication of media and internet-based strategies and campaigns Throughout 2009, the pace of resources and adoption of internet-based strategies and campaigns increased significantly. Virtually all of the major national AIDS organizations, including NASTAD, now have a presence on the various social networking sites such as Facebook and Twitter. NASTAD, the National Minority AIDS Council, the National Association of People With AIDS and many other agencies have "widgets" on their websites linking to these sites. NASTAD has enhanced its presence on the Internet to complement our existing methods of communication, including the NASTAD WordPress weblog, and a LinkedIn page, as well as a presence on Facebook and Twitter. NASTAD also stepped up its efforts to share strategies to deliver Internet-based interventions, and in March 2009, convened a TA meeting to focus on using Internet Partner Services (IPS) to reach gay men and other men who have sex with men. Using footage from the TA meeting, NASTAD developed a four-part web-film that explores IPS, available on NASTAD's YouTube page. Further evidence that internet-based services are on the rise is the publication by the National Coalition of STD Directors (NCSD) of the National Guidelines for Internet-based STD and HIV Prevention. The updated version includes guidelines for Internet-based health communications. The use of new media as internet strategies is clearly a new tool in our prevention arsenal. Natalie Cramer, NASTAD's Associate Director of Prevention, is watching and focusing on these issues in 2010:
back to top > More visible progress in reducing the disproportionate impact on racial/ethnic minority communities HIV/AIDS remains disproportionate among gay men of all races and racial ethnic minority populations. Yet concerted efforts by communities, health departments and federal agencies are resulting in an increasing (albeit still inadequate) number of science-based interventions available for specific racial/ethnic minority communities and gay men. Racial/ethnic minority leadership at all these levels has helped to raise the visibility of the situation among the general public. Dramatic stories such as the crisis in Washington, D.C., where the epidemic rivals that of many African nations, and comments like those presented by NASTAD Chair Heather Hauck at a Congressional briefing on the dire state of the domestic HIV epidemic, have issued a sort of wake-up call to the nation. Add to this the momentum we've seen in response to the National HIV/AIDS Strategy development, the increasing recognition of the need to address syndemics and social determinants, and efforts to achieve efficiencies through integration, and there is recipe for refocusing our efforts on the disproportionate impacts of epidemic/epidemics here at home. With health reform, there is an opportunity and a "will" to make this recipe a reality and change the equation. Perhaps 2010 will provide us with some very tangible success stories in reducing the disproportionate impact of HIV/AIDS in minority communities. back to top > Conclusion As this overview of issues to watch in 2010 attests, our challenges remain no small task. But the tangible optimism in 2009 has led to dogged determination as we have slowly chipped away at the myriad challenges and persevered in the face of shrinking dollars. There seems to be a renewed energy and new avenues to pursue to "ever expand our prevention arsenal" and indeed, find new ways to scale up our efforts. As President Obama stated in his press release released for National HIV Testing Day:
Meeting and Planning Calendar December 1, 2009 World AIDS Day February 7, 2010 National Black HIV/AIDS Awareness Day February 16-19, 2010 17th Conference on Retroviruses and Opportunistic Infections, March 8-11, 2010 National STD Prevention Conference, March 10, 2010 National Women and Girls HIV/AIDS Awareness Day March 16, 2010 Hepatitis C 2010: Strategies for a New Decade, 2010 Statewide Hepatitis C Conference, New York, NY March 20, 2010 National Native HIV/AIDS Awareness Day April STD Awareness Month May 2010 Viral Hepatitis Awareness Month May 18, 2010 HIV Vaccine Awareness Day May 19, 2010 National Asian and Pacific Islander HIV/AIDS Awareness Day World Hepatitis Day May 27-30, 2010 HIV/AIDS 2009: The Social Work Response, Denver, CO. Abstracts due December 31. June 8, 2010 Caribbean American HIV/AIDS Awareness Day June 27, 2010 National HIV Testing Day July 18-23, 2010 XVIII International AIDS Conference, Vienna, Austria |
Credits, Feedback and Input The NASTAD Prevention Bulletin is edited by NASTAD staff and is written by staff and prevention experts from around the country. This publication was supported by Cooperative Agreement Number 5U62PS323958-05 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. If you have an idea or program that you would like to include in the Bulletin, please contact Dave Kern or Lynne Greabell (202/434-8090). NASTAD welcomes feedback to issues presented in Bulletin. To submit commentary, please e-mail us at NASTAD@NASTAD.org. Electronic versions of the Bulletin are available on our webpage. |
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