Important note: Information in this article was accurate in 2008. The state of the art may have changed since the publication date.
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Washington Blade - June 6, 2008
Ryan Lee
In 1999, the CDC established the "Diffusion of Effective Behavioral Interventions," which are scientifically supported prevention programs, and are the only type of interventions funded directly by CDC to community-based AID organizations. Of the 16 DEBIs the CDC funded last year, five were geared toward gay and bisexual men.
In an effort to fund broader HIV prevention initiatives, the CDC restructured its DEBI system in 2007, replacing it with a "Compendium of Evidence-Based Interventions." The new funding structure categorizes interventions into four tiers based on how much scientific evidence supports their effectiveness, with Tiers I and II having a higher scientific standard and a higher likelihood of receiving CDC funding.
The CDC's compendium currently includes only Tier I and II interventions, with only four of the 49 interventions targeting gay and bisexual men.
"It's clearly a need for more intervention research and expanded HIV prevention efforts for [gay and bisexual] men," said Richard Wolitski, acting director of the CDC's division of HIV/AIDS prevention.
Like DEBIs, the Tier I and Tier II interventions were tested in controlled scientific studies, and their results were published in a peer-reviewed journal. After the CDC implemented such a high scientific threshold, many of the HIV prevention efforts organically created by gay men and AIDS organizations during the 1980s and 1990s were no longer eligible for CDC funding.
"I think there was a misperception that there was a sufficient amount of research that had been done on [gay and bisexual] men earlier in the epidemic," Wolitski said. "The main concerns are that we meet the needs of persons who are at greatest risk of HIV infection, and that we meet those needs with the most effective interventions possible."
With a recent surge in HIV cases among gay men, critics said the CDC's compendium reveals "a real lack of focus."
"This is a glaring, glaring omission and it needs to be corrected," said Carl Schmid, director of federal affairs for the AIDS Institute, an advocacy group that criticized the CDC's compendium in an analysis last month.
"Why did they let this happen over all these years? And what are they going to do about it, because something is completely wrong here," Schmid said.
The CDC is exploring new interventions for black and Latino gay men, transgender individuals and gay substance abusers, with each of those interventions at different stages of development, Wolitski said.
The years of scientific investment required for an intervention to be included in the compendium means CDC lacks flexibility in its fight against a rapidly spreading disease, said A. Cornelius Baker, national policy adviser for the National Black Gay Men's Advocacy Coalition.
"Until that research has been conducted, we have a large gap," Baker said. "We really are in an emergency situation and we need to move forward."
Baker was part of a group of black gay leaders who met with CDC officials in April to stress the need for more prevention programs for black gay men, a population that some studies have shown to have a HIV infection rate of 46 percent.
Some Tier I and Tier II interventions have been successfully adapted to target certain gay populations, Wolitski said. The CDC also funds state and local health departments, which have the discretion to fund HIV prevention programs that are not included in the CDC's compendium, Wolitski added.
But many health departments adhere to the CDC's standards, making it difficult for creative new interventions to receive funding, Baker said.
Although gay and bisexual men account for 50 percent of HIV cases in the U.S., health departments across the country on average spend 20 percent of their budgets targeting that population, according to an analysis by The AIDS Institute.
"It's not only that the number of interventions [offered by the CDC] is obviously lacking, but the money is not being spent" targeting gay and bisexual men at the state level, Schmid said.
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