coates china

Slide1: 

CDC-NIMH Conference Closing Meditations Thomas J. Coates PhD Professor of Medicine Director, AIDS Research Institute University of California San Francisco CA USA

Slide2: 

Risk behavior and HIV incidence increases Risk behavior and HIV incidence increases

Challenge #1Can China Avoid Making Everyone Else’s Mistakes: 

Challenge #1 Can China Avoid Making Everyone Else’s 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

Slide5: 

1984 838 AIDS Cases/491dead

Slide6: 

7569 AIDS Cases/5589 dead 1989

Slide7: 

20,333 AIDS Cases/14,349 dead 1994

Slide8: 

27982 cases 18957 deaths

Rectal gonorrhea among MSM: 

Rectal gonorrhea among MSM Preliminary: Continued increase into 2002 Source: City-wide STD case surveillance.

Early syphilis among MSM: 

Early syphilis among MSM Preliminary: Continued increase into 2002 Source: City-wide STD case surveillance. Note: figures updated from abstract.

New HIV Infections, 1997 vs. 2001: 

New HIV Infections, 1997 vs. 2001

New HIV Infections, 1997 vs. 2001: 

New HIV Infections, 1997 vs. 2001

Other prevention technologies: 

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

Public Health Decisions: 

Public Health Decisions Evidence-based Values-based Security-based Constituency-based

Injection Drug Users: 

Injection Drug Users Opportunities to do study the impact of harm reduction strategies Opportunities to prevent vertical transmission

Other Challenges: 

Other Challenges Other prevention technologies Populations Topics Methods Issues

Voluntary Counseling and Testing: 

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

Populations: 

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

Methods: 

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

Topics: 

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

Probability of Survival After AIDS Diagnosis by Race, San Francisco, 1993-1995: 

Probability of Survival After AIDS Diagnosis by Race, San Francisco, 1993-1995

Probability of Survival After AIDS Diagnosis by Race, San Francisco, 1996-1999: 

Probability of Survival After AIDS Diagnosis by Race, San Francisco, 1996-1999

Slide23: 

HAART use by neighborhood, San Francisco, 2001

Slide24: 

5 year survival by neighborhood, San Francisco, 2001

Economic Development and Cultural Change: 

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

Surveillance: 

Surveillance National and local Multidimensional and comprehensive Regular intervals

Stigma: 

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

Stigma: 

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

Technology Transfer: 

Technology Transfer Efficient and effective Quick Adaptable With high quality No need to “reinvent the wheel”

Blood Safety: 

Blood Safety Ongoing study Motivations for donation Motivations and strategies for self-deferral

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

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