The federal Centers for Disease Control and Prevention (CDC) announced $49 million in HIV prevention grants that require grantees to prove that their efforts are effective and focus more on doing prevention among people who are already infected with the virus.
“This was a highly competitive program announcement,” said Dr. Robert S. Janssen, director of CDC’s HIV prevention programs during a May 21 telephone briefing with reporters.
Only 142 AIDS groups out of the 537 across the nation that applied will be funded and the average grant size is $345,000 for the first year of the five-year program. The $49 million is just a portion of the $788 million that CDC will spend on domestic HIV prevention efforts this fiscal year.
Twenty-three million will fund prevention efforts targeting people who are already infected and their partners as well as people at “very high risk” of becoming infected, according to Janssen.
Another $14 million will be for HIV counseling and testing and the remaining $13 million will be spent on health education and risk reduction efforts.
The grant awards showed a general shift of cash away from AIDS groups in the Northeast, Midwest, and West and towards groups in the South. Part of the reason for that shift is the quality of the applications, but also because the CDC used data on AIDS cases to determine where the need was.
Janssen said that from 1996 to 2002 AIDS cases had grown in the South, decreased in the West and remained stable in the Northeast and Midwest.
“That explains some of the shift to the South,” Janssen said. “It doesn’t necessarily explain all of the shift.”
AIDS case data does not reflect the current state of the epidemic because it can take a person as long as ten years to go from testing HIV-positive to having AIDS. Janssen said that there were not yet reliable HIV case reporting systems in place in all 50 states and the nation’s capitol.
“AIDS data are the only complete data that we have nationwide,” Janssen said. “We do not a stable HIV reporting system yet.”
Forty-one percent of the cash will fund programs serving gay and bisexual men, programs targeting heterosexuals will get 38 percent, and efforts aimed at injecting drug users will get 20 percent.
“What seems to have happened is that the organizations serving men who have sex with men have requested more money or they are doing more expensive interventions,” Janssen said. “There actually is a very large increase going to organizations serving MSM.”
Eighty-two percent of the $49 million will go to groups serving African Americans, Latinos, Asian and Pacific Islanders, and Native Americans.
In addition to putting more money into so-called prevention for positives, the CDC required applicants to include performance indicators, or measures of whether or not the funded program is doing what it claims to do, in their proposals.
“The announcement included some specific items that are called program performance indicators,” said Dr. Harold W. Jaffe, director of CDC’s National Center for HIV, STD and TB Prevention, last year when the agency sought applications. “They attempt to set goals... For example, let’s say one of your activities is outreach and testing. One indicator might be the percent of newly-identified positive tests that were returned to a client.”
Janssen said there were no trends in how the applicants responded to the performance indicator requirement. The CDC is negotiating with the successful applicants to determine what shape their final programs will take. Those negotiations will be completed by July 1.
Twenty-eight AIDS or community groups across New York State were funded including ten that serve gay and bisexual men. Those groups included the Gay Men’s Health Crisis (GMHC), Gay Men of African Descent, and People of Color in Crisis (POCC).
“The CDC grant will enable GMHC and other community based organizations to create and implement targeted HIV prevention efforts among men who have sex with men in the communities that have the highest incidence of HIV infection rates,” wrote Lynn Schulman, a GMHC spokesperson in a press statement.
Gary English, executive director of the Brooklyn-based POCC, said his group would likely spend its money on expanding its HIV testing efforts and on Many Men, Many Voices, an HIV prevention program.