Date: Tue, 19 Jul 1994 11:59 +0000 From: MLV.APA@email.apa.org (Volkov, Marina) 7. AIDS PROGRAM ADVISORY COMMITTEE MEETS TO APPROVE DISCRETIONARY FUNDING Meeting for the last time, the AIDS Program Advisory Committee (APAC) reviewed the planning process for the FY96 AIDS research agenda and considered the disbursement of the Office of AIDS Research (OAR) Director's Discretionary Fund. The NIH Reauthorization Act of 1993 empowered the OAR with budget authority for all appropriated AIDS dollars and established an advisory council to approve funding decisions. APAC as currently configured acts only to advise on the direction of AIDS programs and approve the discretionary funding decisions and therefore will be obsolete with the establishment of the advisory council, now pending the Secretary's approval. OAR Director William Paul stepped through the FY96 planning process with APAC. This plan takes on great importance, in that for the first time distribution of AIDS dollars will be determined by it. A five-year plan was completed in 1993 but is updated annually. For FY96 Paul stated that a reappraisal had brought about some changes, but no significant readjustment. Paul was pleased with the process and the plan and remarked that he hopes to "strike a balance between helping those who already have the disease and prevention." The plan is divided among five priority areas, including: natural history and epidemiology; etiology and pathogenesis; therapeutics; vaccines; and behavioral research. For each area there is a discussion of current knowledge and a defining of objectives. Interestingly, among the objectives contained in each area was a behavioral component. Among the objectives in the behavioral research area were: developing multidisciplinary behavioral intervention strategies; supporting basic behavioral and social research on principles of behavior and behavior change; information dissemination of state-of-the-art information; and the building of a behavioral and social science infrastructure. Among the very few criticisms to be voiced concerning the plan was that there should be more attention paid to making the link between research findings and clinical practice. It was also felt that the members of subcommittees considering each of the five areas should have some time to deliberate together to allow for multidisciplinary brainstorming. In considering the $8.8 million that was to be disbursed from the Director's Discretionary Funds, APAC approved supplementing several initiatives in the behavioral and social sciences, amounting to almost 25% of the total funds. Of these, APAC approved a supplement to NICHD's adolescent health survey study (see the March 1994 FEDERATION NEWS). The emphasis placed on the behavioral and social sciences in the planning process and the amount of discret-ionary funds directed toward them bodes well for the future. With the OAR planning process determining budgetary alloca-tions to individual NIH institutes, the continued support of these sciences depends on adequate representation within the OAR and the continued recognition of their importance in stemming AIDS. 8. WAXMAN HOLDS HEARINGS ON AIDS PREVENTION On July 12 the House Subcommittee on Health and the Environment, chaired by Rep. Henry Waxman (D-CA), held a hearing on preventing HIV infection and preventing AIDS. Witnesses at the hearing included Rep. Nancy Pelosi (D-CA) and Rep. Constance A. Morella (R-MD). Philip R. Lee, M.D., the Assistant Secretary for Health of the Department of Health and Human Services, appeared on one of two panels with representatives from the CDC. Members of the second panel included representatives from several AIDS advocacy groups, including the National Minority AIDS Council, the National Association of People with AIDS and the AIDS Action Council. Rep. Pelosi spoke about H.R. 1538, the Comprehensive HIV Prevention Act, which she first introduced in March 1993, and the suggested amendments to that legislation. The bill suggests ways in which the Public Health Service agencies can improve the effectiveness of their respective HIV programs. The main responsibility for an appropriations expenditure plan for HIV prevention activities at each Public Health Service agency is assigned to the Assistant Secretary for Health. In his testimony, Dr. Lee summarized some of the successful aspects of CDC behaviorally-based HIV prevention programs. Successful program elements included: clearly defined audiences, objectives, and interventions; a use of evaluation findings and mid-course corrections; successful resources and a basis in behavioral and social science theory and research. Dr. Lee pointed out that prevention is currently the most effective means of reducing HIV infection and AIDS, and that more resources are needed for prevention efforts. Rep. Morella echoed that sentiment and noted that the $63 million increase in prevention funding in the House's FY95 Appropriations bill was welcome in a difficult funding year. Rep. Pelosi noted that the CDC established guidelines for state and local health departments to institute planning groups which would have shared responsibility for setting priorities for HIV prevention programs (see the January 1994 FEDERATION NEWS). These groups would include health department representatives as well as community group representatives, especially the at-risk members of the community. Rep. Pelosi indicated that emphasis should be placed at the local, and not exclusively state, level in regard to HIV prevention planning. Finally, Rep. Pelosi stated that technical services, including intervention models and effective program evaluations, are of great need to community- based HIV prevention providers and will be the distinguishing characteristic of a successful program. Members from the AIDS advocacy groups strongly suggested that future HIV prevention programs be culturally relevant, focus on changing an individual's behavior and specifically target the at-risk community and their peers. The members believe that more media campaigns regarding HIV would be effective, coupled with school education programs and community prevention programs. It was theorized that HIV prevention information from many different sources would be effective. The most important and final point made by advocacy representatives was that prevention and behavioral changes must be realistically achievable and socially acceptable to be truly effective.