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

3. Risk behavior and HIV incidence increases Risk behavior and HIV incidence increases

5. Challenge #1 Can China Avoid Making Everyone Else’s Mistakes ò Keep prevalence low? ò Not allow treatment to reduce prevention efforts ò Convince people that HIV is still not a good disease to have ò Make sure that everyone gets treatment

6. 1984 838 AIDS Cases/491dead

7. 7569 AIDS Cases/5589 dead 1989

8. 20,333 AIDS Cases/14,349 dead 1994

9. 27982 cases 18957 deaths

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

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

12. New HIV Infections, 1997 vs. 2001

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

15. Public Health Decisions ò Evidence-based ò Values-based ò Security-based ò Constituency-based

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

17. Other Challenges ò Other prevention technologies ò Populations ò Topics ò Methods ò Issues

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

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

20. Methods ò Behavioral reports ò Multidisciplinary strategies ò Bringing in economics, law, policy

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

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

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

24. HAART use by neighborhood, San Francisco, 2001

25. 5 year survival by neighborhood, San Francisco, 2001

26. Economic Development and Cultural Change ò Economic development leads to ò Decreased age of first intercourse ò Increased access to the internet and sexually explicit materials ò Increased risk behavior ò Commercial sex ò More mobility ò Less access to health care

27. Surveillance ò National and local ò Multidimensional and comprehensive ò Regular intervals

28. Stigma ò How stigma impacts various groups ò Attitudes towards persons with HIV and how this impacts availability of and access to services ò Combined stigmas: drug use, homosexuality, poverty, HIV, commercial sex ò Access to treatment and prevention services ò Legislation and policy and its impact on stigma ò Impact of treatment on stigma

29. Stigma ò Community, mass media, and other social interventions ò Intervene with perpetrators of stigma ò Intervene with public health officials and policy makers ò School-based interventions to reduce stigma ò Programs for parents

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

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

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