Provost Briefs Lawmakers About SPH AIDS Report

Provost Harvey V. Fineberg '67 headed to the capital last week to talk about how the United States should change its strategy for combating AIDS.

Fineberg, formerly the dean of the School of Public Health, co-chaired a committee of health policy experts and academics that released a report on the topic last month, and he attended briefings in Washington to explain it.

The report, issued under the auspices of the Institute of Medicine of the National Academies, recommends that the U.S. better track HIV infections and fund the most cost-effective prevention programs. According to the report, such measures could dramatically cut the number of new infections.

Fineberg says although HIV and AIDS treatments have improved in recent years, more must be done.

"Thousands of new HIV infections could be avoided each year if we gave greater emphasis to prevention, and were smarter in the way we spent our prevention dollars," Fineberg says. "Improved treatments may have contributed to a false sense of security and a dangerous complacency but the need for prevention has not diminished one bit."

The committee was formed about a year ago, when the U.S. Centers for Disease Control and Prevention requested that the Institute of Medicine outline how the U.S. might better approach the issue of AIDS.

The committee's report stated that the nation needs to have an explicit policy goal: preventing as many HIV infections as possible with the available resources. To that end, infections need to be tracked with a better system than that which is currently used.

""By focusing mainly on AIDS cases, where diagnosis lags behind HIV infection by approximately 10 years without treatment and even longer with treatment, today's surveillance system looks at the past rather than to the future and tracks where the epidemic has been rather than where it is going. This lag is particularly problematic in light of the reality that the epidemic has shifted into new population groups," said James Trussell of Princeton University, who also co-chaired the committee, in a press release.

The committee also addressed the problem of social barriers. It noted that the federal government planned to spend money on abstinence programs without any evidence that they worked. On the other hand, safe-sex education has proven to have an effect.

The committee also recommended that all laws and policies preventing the use of proven preventive strategies be abolished. They particularly cited federal, state and local requirements preventing public funds from being used for safe-sex education.

In fiscal year 1999, the federal government spent approximately $775 million on HIV and AIDS --8 percent of the federal budget for HIV/AIDS programs.

Fineberg notes that the committee's work had been released around election season, in time to alert the next occupant of the Oval Office to the issue's importance.