Can China Avoid making everyone elses' mistakes

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CDC-NIMH Conference Closing Meditations Thomas
J. Coates PhD Professor of Medicine Director,
AIDS Research Institute University of
California San Francisco CA USA
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• Risk behavior and HIV
• incidence increases

Risk behavior and HIV incidence increases
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(No Transcript)
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Challenge 1Can China Avoid Making Everyone
Elses Mistakes

• Keep prevalence low?
• Not allow treatment to reduce prevention
  efforts
• Convince people that HIV is still not a
  good disease to have
• Make sure that everyone gets treatment

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1984
838 AIDS Cases/491dead
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1989
7569 AIDS Cases/5589 dead
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1994
20,333 AIDS Cases/14,349 dead
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27982 cases 18957 deaths
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Rectal gonorrhea among MSM
Preliminary Continued increase into 2002
Source City-wide STD case surveillance.
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Early syphilis among MSM
Preliminary Continued increase into 2002
Source City-wide STD case surveillance. Note
figures updated from abstract.
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New HIV Infections, 1997 vs. 2001
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New HIV Infections, 1997 vs. 2001
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Other prevention technologies

• Female-controlled methods including
  diaphragm
• Circumcision
• New VCT Technologies
• Appropriate STI control
• e.g., for viral infections
• Penile wipes

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Public Health Decisions

• Evidence-based
• Values-based
• Security-based
• Constituency-based

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Injection Drug Users

• Opportunities to do study the impact of harm
  reduction strategies
• Opportunities to prevent vertical transmission

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Other Challenges

• Other prevention technologies
• Populations
• Topics
• Methods
• Issues

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Voluntary Counseling and Testing

• Preventive strategy vs Intro to treatment vs
  surveillance
• Training and quality assurance for counseling
• New testing technologies for specific
  populations

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Populations

• Infected individuals--positive
  prevention
• Pregnant women
• MSM and male CSWs
• Military
• Prisons
• The poor, especially the urban poor

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Methods

• Behavioral reports
• Multidisciplinary strategies
• Bringing in economics, law, policy

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Topics

• Evidence-based policy research
• Substance abuse and mental health
• Changing sexual norms
• Economic disparities

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Probability of Survival After AIDS Diagnosis by
Race, San Francisco, 1993-1995
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Probability of Survival After AIDS Diagnosis by
Race, San Francisco, 1996-1999
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HAART use by neighborhood, San Francisco, 2001
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5 year survival by neighborhood, San Francisco,
2001
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Economic Development and Cultural Change

• Economic development leads to
• Decreased age of first intercourse
• Increased access to the internet and
  sexually explicit materials
• Increased risk behavior
• Commercial sex
• More mobility
• Less access to health care

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Surveillance

• National and local
• Multidimensional and comprehensive
• Regular intervals

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Stigma

• How stigma impacts various groups
• Attitudes towards persons with HIV and how
  this impacts availability of and access to
  services
• Combined stigmas drug use, homosexuality,
  poverty, HIV, commercial sex
• Access to treatment and prevention services
• Legislation and policy and its impact on
  stigma
• Impact of treatment on stigma

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Stigma

• Community, mass media, and other social
  interventions
• Intervene with perpetrators of stigma
• Intervene with public health officials and
  policy makers
• School-based interventions to reduce stigma
• Programs for parents

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Technology Transfer

• Efficient and effective
• Quick
• Adaptable
• With high quality
• No need to reinvent the wheel

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Blood Safety

• Ongoing study
• Motivations for donation
• Motivations and strategies for self-deferral

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Ari.ucsf.eduwww.caps.ucsf.eduwww.ucsf.edu and
then go to web sites and then to AIDS Research
Institute
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