Investing social capital  pg. 3

One important reason is resources. There have been at least two published estimates of how much additional resource would have to be made available for a person at risk of infection or transmission in the U.S. to receive good quality prevention services.

The best estimate is about $300 million a year. That would mean that CDC’s budget would have to go from about $700 million to about $1 billion per year.

However, over the last few years, if you adjust for inflation, the investment in prevention in the U.S. is either staying the same or actually going down a little bit. And so unless we expand our efforts to try and address these unmet needs, we’re going to fall short. I am hoping that the $93 million increase for domestic HIV prevention in the president’s fiscal year 2007 budget proposal is one step in a better direction.

Another very important issue is having science-based prevention tools that we know make a difference, yet seeing those interventions sit on the shelf—not be able to be used.

Take needle and syringe exchange programs. A lot of scientific studies show that they do seem to make a difference in terms of reducing needle sharing and reducing HIV infections. They have even been found to be cost-effective. But there continues to be the ban on use of federal money for needle and syringe exchange programs.

Some states, cities and private funders have started to make up some of that difference, but still the federal ban is an important barrier.

The third major area, discrimination and stigma, is also very important to address in this society. If populations who are disproportionately impacted with HIV are discriminated against or stigmatized, it’s very hard to put in place effective prevention services.

Dr. Pape, are you seeing these kinds of barriers also in Haiti?

We have the same (problems) but with much greater magnitude. Haiti has a lot the problems that facilitate HIV transmission.

We started with a very high HIV seroprevalence; we have the highest HIV seroprevalence outside of Africa. We are the poorest country in the Caribbean, (and have) high rates of sexually transmitted diseases, which are known to be cofactors for HIV transmission.

We have what I would call sexual promiscuity, because men have contact with many women and have contact with commercial sex workers. At one point in 1982, 62 percent of sex workers were HIV infected.

We have a high illiteracy rate—about 40 percent. But still at the time when we had very little resources, with prevention in particular, we’ve been able to reduce the seroprevalence rates in documented national surveys from 6.2 percent in 1993 to 3.1 percent in 2003.

They’re going to have another (survey) this year, and I expect that (the rate) will be lower than 3 percent.

What can the United States learn from research conducted in resource-poor countries in the developing world?

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