In addition to the three performance indicators, CDC has implemented programs and activities that focus on decreasing the numbers of persons at high risk for acquiring or transmitting HIV infection, specifically relating to Objectives 1, 2, and 4 of Goal 1.

CDC's HIV/AIDS surveillance system is the nation's key source of information used to track the epidemic. Surveillance activities provide demographic, laboratory, clinical, and behavioral risk data that are used to identify populations at greatest risk for HIV infection. In 2001, CDC began implementation of a national, population-based incidence surveillance system to provide estimates of HIV incidence using a testing technology known as STARHS (Serologic Testing Algorithm for Recent HIV Seroconversion). STARHS is a way of analyzing HIV-positive blood samples to determine if an HIV infection is recent. To date, 34 areas that cover approximately 90% of the epidemic in the United States have been funded for HIV incidence surveillance. CDC expects to have incidence data available in 2006. This new national system for measuring the rate of new HIV infections in the United States is expected to provide the clearest picture yet of the magnitude of the domestic HIV epidemic, as well as aid CDC in more effectively targeting HIV prevention efforts to promote decreases in the incidence of new HIV infections.

CDC has also implemented the National Behavioral Surveillance System (NHBS) to learn more about risk behaviors among groups of persons at high risk for HIV infection, trends in these behaviors over time, and exposure to and use of HIV prevention services. As of 2004, CDC has funded 25 Metropolitan Statistical Areas (MSAs) to implement behavioral surveillance for three groups at highest risk for acquiring HIV infection: men who have sex with men (MSM), injection drug users (IDUs), and heterosexuals practicing high-risk sexual behaviors. These groups will be surveyed every 3 years so that trends in risk behaviors can be monitored and effective HIV prevention programs can be developed and implemented that encourage the adoption of behaviors that place these groups at lower risk for HIV infection or transmission.

In an effort to assure that scientifically sound interventions are available to prevention service providers, planners, and others who request science-based interventions, CDC has conducted a systematic literature review of HIV prevention interventions that have been formally evaluated and shown to reduce the risk of HIV transmission. The results of this review are compiled in the Compendium of HIV Prevention Interventions with Evidence of Effectiveness (Compendium) . The Compendium provides up-to-date information about interventions with evidence of reducing sex-and/or drug-related risks, and the rate of HIV/STD infections. These interventions have been effective with a variety of populations, e.g., clinic patients, heterosexual men and women, high-risk youth, incarcerated populations, IDUs, and MSM.

The Diffusion of Effective Behavioral Interventions (DEBI) project is an additional activity that brings evidence-based prevention interventions to the field. The DEBI project involves development and distribution of intervention resource materials, training on the interventions, and technical assistance and other capacity building strategies around the interventions. Currently, CDC has diffused 14 evidence-based prevention interventions to health department and community-based organization (CBO) partners though regional DEBI trainings. From January 2003 through November 2005, 251 regional DEBI trainings have occurred. More than 1500 CBOs and 329 local or state health departments have participated in these trainings and approximately 5000 individuals have been trained on one or more of the DEBIs.

CDC's Advancing HIV Prevention (AHP) initiative, launched in April 2003, expanded and strengthened prevention efforts by adding new prevention strategies based on proven public health approaches that have been used successfully in preventing other infectious diseases. The four AHP strategies are:

• Make HIV testing a routine part of medical care
• Implement new models for diagnosing HIV infections outside medical settings
• Prevent new infections by working with persons diagnosed with HIV and their partners
• Further decrease perinatal HIV transmission

In support of the AHP initiative, CDC provided funding for seven 2-year demonstration projects to health departments, CBOs, and primary care providers to test the feasibility of the four AHP strategies and provide detailed information that could be used to implement the strategies widely.

Go to Goal 1 Objective 1