Boos and hisses during parts of Claude Allen's closing remarks at the 2003 HIV Prevention Conference in Atlanta July 30 clearly demonstrated the tension that exists between much of the HIV prevention community and the Bush administration. The Deputy Secretary for Health and Human Services appeared to be caught off guard by the reaction.
Allen tried to allay fears that recent prevention initiatives by the Centers for Disease Control and Prevention (CDC) would result in defunding community-based prevention efforts. Those initiatives, such as increased testing and a focus on prevention for positives, were developed solely within CDC and without consultation with the affected communities.
'The Secretary and I recognize that CBOs [community-based organizations] are integral players and will continue to play a very central role in implementing this new initiative. This will include an expanded role for CBOs in terms of HIV testing, outreach, and prevention counseling,' he said. But the catch is, the CBO must be capable of adapting to the new initiatives.
Allen touted the Uganda ABC model of HIV prevention where 'A is abstinence in young people. B is being faithful within a relationship. And C is condom use in high-risk populations, with the knowledge that condoms are not as effective in preventing all sexually transmitted diseases as they are in terms of preventing HIV.'
'Encouraging young adults and youth to abstain is the only appropriate initial strategy to making informed decisions,' ordered Allen. This evoked boos from the audience of 3,000 HIV prevention researchers and outreach workers. They intensified as Allen continued, 'Whether youth identifies him or herself as heterosexual, gay, or questioning, delay of sexual debut must be the first message that they receive.'
'For young adults, however, who choose not to honor delayed sexual debut, we must reinforce the importance of entering into relationships committed to monogamy.' A ripple of laughter surged through the audience.
'Lastly, for these individuals [who do not abide by abstinence or monogamy] we must encourage the adoption of safer sex practices and the consistent use of condoms, with the knowledge, again, that they are not always 100% effective.'
At one point during Allen's speech, activists walked the aisles holding up pink pieces of paper that read, 'Stop the war on HIV prevention.' Among the ten points raised on the back of the flyer were the Bush administration's flat funding of prevention activities; right-wing pressure to tone down explicit messages; and a criticism of the shift from community-based to more of a medical model for prevention activities.
'Abstinence-based programs have a role in dealing with young people before the onset of sexuality and sexual activity,' said Terje Anderson, executive director of the National Association of People With AIDS (NAPWA), in a conversation at the close of the conference. 'But it is clear that people need a comprehensive approach to health to make the decisions based on where they are in their lives at that time. And that is not the kind of program that he [Allen] advocated.'
'I think that he was surprised by the reception that he got here [boos]. And the fact that so many people in the community and researchers were willing to stand up with the message was significant. Hopefully it will push the discussion to where we need to go.'
'For the last several months we haven't been heard at all,' said Anderson. 'We had to organize to make that happen, but it is clear that it is finally happening. We need to make sure that continues. There are still a lot of details on the initiative that need to be worked through.'
'The new strategy will only provide health and education after someone has become HIV positive, which we think is a tragedy,' said David Munar with the AIDS Foundation of Chicago. 'This is not cholesterol we are talking about, where you can screen people and give them treatment. This is a 100% preventable disease and we have to do all we can to reach people before they become infected.
'Prevention is grossly under funded already in communities of color and poor communities, among youth, among men who have sex with men. We're afraid that this initiative that focuses on testing and prevention for positives, two approaches that we think are valuable, are going to decimate our community.'
'We are against lying to young people,' said Munar. 'We oppose abstinence only until marriage because that is not going to resonate with the most at-risk young people, especially Latino or gay, bisexual, transgender youth.
'We believe that they can assimilate all of the information and make informed decisions about their sexual health, if you reach them early enough, and give them all of the tools, and tell them about the benefits of abstinence, but also about the consequences of becoming sexually active.'
'In some ways the conference feels like a farce,' said Munar. 'We have been allowed to have a rich exchange of ideas but yet funding is not going to increase and our very scarce resources have already been designated for these medical interventions and prevention for positives, testing at the expense of prevention.'
'We are not getting the kind of support that we need from the government or the private sector at this point,' added Marsha Martin, executive director of the AIDS Action Council. 'We are being asked to do the impossible with nothing. That we can't do. So it is time to regroup.'
She saw the conference as 'a nice overview' of research and prevention activities. 'But we didn't get into the conversation of what really needs to be done today, the strategies that we are going to have to develop to make a difference in this epidemic today.'
Martin did point to a silver lining in Claude Allen's speech. 'I don't know that we have ever had a Deputy Secretary that has ever said safer sex as a practice of prevention of HIV. I think that we should seize on that.'
