Boos and hisses during parts of Claude Allen’s closing remarks at the 2003 HIV Prevention Conference in Atlanta, Georgia, July 30 clearly demonstrated the tension that exists between much of the HIV prevention community and the Bush administration. The Deputy Secretary for Health and Human Services appeared to be caught off guard by the reaction. Allen tried to allay fears that recent prevention initiatives proposed by the Centers for Disease Control and Prevention (CDC) would result in defunding community-based prevention efforts. Those initiatives, such as increased testing and a focus on prevention efforts geared towards those who are already HIV- positive, were developed solely within CDC and without consultation with the affected communities, critics say.

Late last month, new figures showed that AIDS diagnoses had increased for the first time in 10 years. Last year, 42,136 new AIDS cases were diagnosed in the United States, up 2.2 percent from the previous year. The number of gay and bisexual men infected with HIV was also up for the third year in a row, after a decade of declining numbers.

Health officials say prevention efforts have stalled, and they are changing their strategy from one of preventing new cases to counseling those who already have HIV in an attempt to get them to stop spreading the virus.

The CDC estimates 850,000 to 950,000 Americans are living with HIV, and nearly 385,000 of those have full-blown AIDS. New threats have also emerged: up to 15 percent of new HIV cases in the country are believed to have drug-resistant strains of the virus.

“The Secretary and I recognize that CBOs [community-based organizations] are integral players and will continue to play a very central role in implementing this new initiative,” Allen told those at the conference. “This will include an expanded role for CBOs in terms of HIV testing, outreach and prevention counseling.”

However, the catch is that the CBO must be capable of adapting to the new initiatives. Allen touted the Uganda ABC model of HIV prevention where, “A is abstinence in young people; B is being faithful within a relationship; and C is condom use in high-risk populations, with the knowledge that condoms are not as effective in preventing all sexually transmitted diseases as they are in terms of preventing HIV.”

“Encouraging young adults and youth to abstain is the only appropriate initial strategy to making informed decisions,” Allen told the crowd, which caused a tide of boos from the audience of 3,000 HIV prevention researchers and outreach workers. The disgruntled din intensified as Allen continued: “Whether a youth identifies him or herself as heterosexual, gay, or questioning, delay of sexual debut must be the first message that they receive.

“For young adults, however, who choose not to honor delayed sexual debut, we must reinforce the importance of entering into relationships committed to monogamy,” Allen added, to a ripple of laughter surging through the audience.

“Lastly, for these individuals [who do not abide by abstinence or monogamy] we must encourage the adoption of safer sex practices and the consistent use of condoms, with the knowledge, again, that they are not always 100 percent effective.”

At one point during Allen’s speech, activists walked the aisles holding up pink pieces of paper that read, “Stop the war on HIV prevention.” Among the 10 points raised on the back of the flyer were the Bush administration’s flat funding of prevention activities, right-wing pressure to tone down explicit messages, and a criticism of the shift from community-based to more of a medical model for prevention activities.

“Abstinence-based programs have a role in dealing with young people before the onset of sexuality and sexual activity,” said Terje Anderson, executive director of the National Association of People With AIDS (NAPWA), in a conversation at the close of the conference. “But it is clear that people need a comprehensive approach to health to make the decisions based on where they are in their lives at that time — and that is not the kind of program that he [Allen] advocated.

“I think that he was surprised by the reception that he got here [boos],” Anderson continued. “And the fact that so many people in the community and researchers were willing to stand up with the message was significant. Hopefully it will push the discussion to where we need to go…. There are still a lot of details on the initiative that need to be worked through.”

“The new strategy will only provide health and education after someone has become HIV-positive, which we think is a tragedy,” said David Munar, of the AIDS Foundation of Chicago. “This is not cholesterol we are talking about, where you can screen people and give them treatment. This is a 100 percent preventable disease and we have to do all we can to reach people before they become infected.

“Prevention is grossly under-funded already in communities of color and poor communities, among youth, among men who have sex with men,” Munar added. “We’re afraid that this initiative that focuses on testing and prevention for positives — two approaches that we think are valuable — are going to decimate our community.” “We are against lying to young people,” Munar said. “We oppose abstinence only until marriage because that is not going to resonate with the most at-risk young people, especially Latino or gay, bisexual or transgender youth…. We believe that they can assimilate all of the information and make informed decisions about their sexual health, if you reach them early enough, and give them all of the tools, and tell them (not only) about the benefits of abstinence, but also about the consequences of becoming sexually active.”

“In some ways the conference feels like a farce,” Munar concluded. “We have been allowed to have a rich exchange of ideas but yet funding is not going to increase and our very scarce resources have already been designated for these medical interventions and prevention for positives, testing at the expense of prevention.”