The Work Group identified a number of factors that hindered progress toward achieving the Plan’s goals and objectives. The following list includes barriers related to leadership, resources, policies, and levels of intervention:

• Insufficient leadership and strategic partnering
  • Absence of national leadership / sense of urgency to market the Plan
  • Lack of community / broad-based buy-in for the Plan
  • Lack of partnership coordination & collaborative action
    • The scope of the Plan was too narrow to include all of the potential partners needed to bring about prevention
    • Inadequate interconnection w / other federal partners (SAMSHA, etc.)
• Inadequate resources
  • Flat funding during the period of the Plan
  • Impact of intervening emergencies such as the 9/11 disaster o Reduced and diverted resources among community-based organizations o Lack of adequate investments in communities of color o Lack of access to services for highest risk populations such as MSM, youth, and women
• Obstructive federal policies / practices
  • Prohibitions against funding needle exchange
  • OMB/GAO program reviews of organizations serving gay populations
  • Shifting policies / distorted information on abstinence and condom use
  • Blocked release of compendium, adolescent health curriculum etc
  • Leadership gaps / capacity issues at CDC
• Inadequate framework & interventions
  • Neglect of macro & structural factors that facilitate HIV transmission o Insufficient targeting of interventions to highest risk groups o HIV exceptionalism (treating HIV differently from other diseases)
  • HIV-related stigma o Disconnect between prevention messages and counseling and testing strategies
  • No national social marketing campaign
  • Inadequate capacity building to deliver effective prevention services and interventions
• Prevention fatigue
  • Prevention “fatigue and burnout” caused communities to ignore CDC’s prevention messages