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2004-2006 National Service Project Proposal: HIV/AIDS: Thinking Globally, Acting Locally
Contributors: Sunny Ramchandani (Yale Univ. School of Medicine), Genia Crumb (New York Medical College), Erin Wilkes (Columbia Univ. College of Physicians and Surgeons), Channing Paller and Rachelle Pierre (Harvard Medical School), Daryl Osbahr (Univ. of North Carolina at Chapel Hill School of Medicine), Kevin Shute (Wake Forest Univ.), Hajar Kadivar (Univ. of Tennessee College of Medicine), Shubhada Hooli (Univ. of Florida, College of Medicine), Veronica Gonzalez (Texas A&M Univ. School of Medicine), Brooke Bible (Univ. of Mississippi School of Medicine), Mark Brady (Brown Medical School), Jacquie Firth (Tulane Univ. School of Medicine) Kate Devine (Albert Einstein College of Medicine) and Albert Hsu (Albert Einstein College of Medicine) I. Supporting AMA Policies: Primary Supporting Policies: H-20.922 H-20.920 H-170.977 H-20.904 H-20.905 H-20.908 H-20.907 H-20.910 H-440.886 H-20.915 H-20.921 H-95.976 H-20.903 HIV/AIDS as a Global Public Health Priority HIV Testing Comprehensive Health Education HIV/AIDS Education and Training HIV/AIDS Research Medical Care of HIV-Infected Patients Financing Care for HIV/AIDS Patients HIV-Infected Children State Tracking of HIV/AIDS and Other Serious Infectious Diseases HIV/AIDS Reporting, Confidentiality, and Notification HIV/AIDS to be Considered as a Communicable and a Sexually Transmitted Disease Drug Abuse in the United States - the Next Generation HIV/AIDS and Substance Abuse

Secondary Supporting Policies: H-20.912 E-5.057 E-9.131 D-295.970 H-75.994 D-20.995 H-20.917 H-20.916 H-20.918 Guidance for HIV-Infected Physicians and other Health Care Workers Confidentiality of HIV Status on Autopsy Reports HIV-Infected Patients and Physicians HIV Postexposure Prophylaxis for Medical Students During Electives Abroad Contraception and Sexually Transmitted Diseases Universal, Routine Screening of Pregnant Women for HIV Infection Neonatal Screening for HIV Infection Breastfeeding and HIV Seropositive Women Maternal HIV Screening and Treatment to Reduce the Risk of Perinatal HIV Transmission

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II. Importance of Project

Today, on the continent of Africa, nearly 30 million people have the AIDS virus -- including 3 million children under the age 15. There are whole countries in Africa where more than one-third of the adult population carries the infection. More than 4 million require immediate drug treatment. Yet across that continent, only 50,000 AIDS victims -- only 50,000 -- are receiving the medicine they need..... .We have confronted, and will continue to confront, HIV/AIDS in our own country. And to meet a severe and urgent crisis abroad, tonight I propose the Emergency Plan for AIDS Relief -- a work of mercy beyond all current international efforts to help the people of Africa. This comprehensive plan will prevent 7 million new AIDS infections, treat at least 2 million people with life-extending drugs, and provide humane care for millions of people suffering from AIDS, and for children orphaned by AIDS I ask the Congress to commit $15 billion over the next five years, including nearly $10 billion in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean.

President Bush, State of the Union Speech, January 2003

The global AIDS pandemic is the worlds most urgent public health crisis. Over 25 million individuals have died from AIDS, with another 42 million individuals infected worldwide.1 Each day, over 8,200 more people die of AIDS.1 By the year 2010, it is estimated that almost 25 million children will be orphaned due to HIV/AIDS.1 Our AMA recognizes HIV/AIDS as a global health priority. If the pandemic continues to spread at its current rate, the disease will kill more people in 2001-2010 than were killed in all the wars of the 20th century combined.1 Africa has been the most severely hit so far, but HIV/AIDS is now rapidly spreading on other continents. By 2010, for example, the total number of annual deaths in the 15-49 year-old Asian population will increase by up to 40 percent because of HIV/AIDS.1 It is extremely important to note that HIV is not just affecting developing nations; over the past few years, HIV has also been spreading in the United States. It is estimated that 850,000- 950,000 Americans are living with HIV and that, to date, 500,000 persons with AIDS have died.2,3 One quarter of HIV infected persons are unaware they are infected, and they account for an estimated two-thirds of new cases.2 For the first time since highly active antiretroviral therapy (HAART) came into widespread use in the mid-1990s, the incidence of AIDS has increased by 2% between 2001 and 2002.4 A study of 30 areas showed that from 1999 2002, the number of persons living with HIV/AIDS increased by 23% (227,976 to 281,931).5 It is presumed that this number has continued to trend upwards over the past 18 months. New diagnoses among men who have sex with men (MSM) have increased by 14% from 1999 2001; among heterosexuals exposed to HIV through sex, the increase between 1999 and 2001 was 10%.4 In light of data suggesting that HIV incidence is rising among certain populations, the CDC is asking clinicians to renew their efforts at HIV prevention and education. Dr. Helen Gayle, the Director of the Bill and Melinda Gates Foundations HIV, TB, and Reproductive Health Program, suggests that U.S. medical students who wish to help combat this pandemic should (1) help develop a complete comprehensive response to HIV/AIDS domestically; (2) cultivate relationships with legislators and policymakers, making clear that this is an important issue to us; (3) increase awareness that we can now treat HIV/AIDS in resource-poor settings; and (4) promote the idea that providing access, treatment, and clinical support is a global responsibility of the next generation of doctors everywhere. Now that treatments are available and the extent of

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the pandemic is known, it is imperative for our AMA-MSS to act on the HIV/AIDS pandemic by making it the focus of the 2004-2006 National Service Project. III. Goals of the Project Objectives of the Project are as follows (See Figure 1): 1. To implement effective, multi-faceted educational interventions (targeted at both HIV positive and HIV negative populations) that can prevent the spread of HIV/AIDS in local communities. 2. To develop alliances with local institutions (ex: schools, religious organizations, civic groups, and community boards) in order to strengthen/develop community outreach programs and to reinforce public awareness of HIV/AIDS. 3. To foster a collaborative spirit with existing advocacy organizations by collectively developing innovative ideas that can be used to fight the HIV pandemic. 4. To encourage AMA-MSS members to better inform policymakers and legislators about: (a) the grand scope of the pandemic, (b) the effect HIV/AIDS is having on the United States, and (c) the desperate need for increased funds to combat the deadly disease. 5. To provide an international component to the project by (a) encouraging AMA-MSS members to participate in clinical electives, research activities, and outreach programs in developing countries and (b) implementing effective educational interventions (that will have been developed and used by AMA-MSS chapters) in high prevalent areas of developing nations. 6. To provide the AMA-MSS with a service project flexible enough to be implemented at both the local and national levels. For example, medical students can combat the pandemic by raising funds for international programs while also working to locally increase awareness of HIV preventive measures.
Educational Interventions

Reinforce Public Awareness

Community Outreach Programs

AMA-MSS HIV/AIDS: Thinking Globally, Acting Locally

Develop Innovative Ideas to fight the Epidemic

Legislative Advocacy

Form Collaborative Projects with Existing Organizations

International Component

Figure 1. Comprehensive Model for NSP Proposal: HIV/AIDS: Thinking Globally, Acting Locally.

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IV. Local Project Ideas At the local level, the NSP would entail a comprehensive approach that arises from the above model. Local chapters would be able to create individual projects that support existing HIV/AIDS programs and that are in the interest of the community. Using the model proposed above, there can be a concerted effort to combat the HIV pandemic at the local level. A few proposed ideas are as follows: 1. Educating the local community / medical center on the HIV/AIDS pandemic a. Local AMA-MSS chapters could develop educational sessions for elementary, junior high and high school students that educate them about HIV/AIDS prevention. b. Local chapters would be encouraged to sponsor school seminars on the pandemic. For example, AMA-MSS members recruit influential HIV/AIDS scientists or activists to speak at lunchtime lectures or during departmental Grand Rounds. 2. Community Outreach Programs a. AMA-MSS members could hold health fairs at local organizations including: schools, religious organizations, civic groups, and community clubs. These fairs could emphasize not only health information, but also ways for people in the community to become active in the fight against the pandemic. b. The general community could participate in campus HIV/AIDS activities. Invitations for events sponsored by the AMA-MSS members on HIV/AIDS could be published in local newspapers. c. AMA-MSS members could set-up free HIV counseling clinics where local HIV positive patients could be given information on lifestyle choices, coping mechanisms, and medical treatments. 3. Forming Collaborative projects with existing organizations a. Plan local fundraisers that are used for (i) local preventive measures or for (ii) donating medial supplies to communities in developing nations. Local chapters could hold creative fundraisers to raise the money to fight the pandemic. Examples of fundraisers: Throwing theme parties for medical students, selling red ribbons, or putting on concerts with local musicians. All proceeds could go to national or international HIV/AIDS charities. b. AMA-MSS chapters could collaborate with other medical student and community based organizations to sponsor HIV/AIDS campus activities and local community events. 4. Reinforce Public Awareness a. AMA-MSS members could develop school-based displays that highlight the importance of the pandemic. Examples include hallway displays or other visual representations, like an AIDS quilt, or a prominent numeric display (updated daily) showing how many people have died from AIDS within the past year. b. Messages, created by the AMA-MSS membership, highlighting important information on HIV/AIDS could be distributed to all AMA members. c. AMA-MSS chapters could also develop HIV/AIDS public service announcements to be used on local radio stations (with donated airtime from the station).

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5. Legislative Advocacy a. Local AMA-MSS chapters can become strong advocates for fighting HIV/AIDS through letter-writing campaigns and meeting with their local and state government officials. - Objectives of the local advocacy campaigns would be to inform local policymakers of the local expenditures on HIV/AIDS, and how funding preventive measures can actually decrease overall health care costs. b. Create petitions that encourage the local member of Congress to place a high importance on the HIV/AIDS pandemic. 6. International Component a. Encourage all AMA-MSS members to complete HIV/AIDS research projects, clinical electives, or service projects in developing nations. b. Mobilize locally developed HIV/AIDS educational materials to be modified and used in various communities of HIV afflicted countries. V. National Project Ideas At the state and national levels, the NSP would entail a more coordinated advocacy and policybased approach. The comprehensive model shown above would provide a framework to guide the AMA-MSS in affecting change among HIV+ and HIV- populations. A few proposed ideas are as follows: 1. Educational Interventions a. The NSP could involve the development of national AMA-MSS guidelines and a national educational module that could be used by medical students to educate adolescents and adults about the HIV pandemic. b. The AMA-MSS website can include: (i) information on HIV/AIDS, (ii) suggestions for how other students can get involved, (iii) links to useful websites for further information. c. The national AMA-MSS can also assemble a PowerPoint presentation, movies, and other supplemental materials that can be used regularly by local chapters. 2. Community Outreach / Collaborative Efforts a. The AMA-MSS could develop collaborative projects with existing advocacy organizations (ex: Physicians for Human Rights, Health Professional Students AIDS Advocacy Network) in order to launch nation-wide educational campaigns. b. The NSP could also involve the formation of local chapter, state, and regional AMAMSS AIDS Awareness Committees that could coordinate community outreach activities. 3. Legislative Advocacy a. The NSP would involve coordinating the membership of the AMA-MSS to create letter-writing campaigns and a possible AIDS Awareness Day on Capitol Hill. b. Media coverage of local and national AMA-MSS HIV/AIDS events would be posted on the AMA-MSS website and disseminated to all AMA members.

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4. International Component a. AMA-MSS members can use educational modules that are developed locally to aid in the development of innovative programs in the communities of developing nations. i. This would translate the AMA-MSS domestic response to HIV/AIDS into programs that could also benefit the global community. b. AMA-MSS members would be encouraged by the national organization to engage in HIV research activities or to complete infectious disease clerkships (with a focus on HIV/AIDS) at international sites. 5. Funding Sources and Opportunities a. The AMA-MSS could use the collective numbers of its membership to obtain funding for nation-wide public awareness campaigns. b. Grants can be sought from foundations, health agencies, philanthropies, advocacy organizations, and other interested groups in order to bring high-profile speakers to regional and national AMA-MSS meetings. In addition, the funds can be used to host forums and provide seed money for local initiatives. c. A small amount of funding can be awarded on a competitive basis to AMA-MSS members who wish to take advantage of international opportunities that combat the HIV/AIDS pandemic (with a focus on communities that are deeply affected by the disease). References: 1. http://www.unaids.org UNAIDS: The Joint United Nations Programme on HIV/AIDS http://www.phrusa.org/campaigns/aids/call.php. Health Action AIDS website. A Physicians for Human Rights Project. 2. http://ww.cdc.gov/hiv/partners/QuickFacts.htm CDC: AHP Initiative Quick Facts 3. http://www.cdc.gov/hiv/stats.htm CDC: HIV/AIDS Basic Statistics 4. http://www.cdc.gov/hiv/stats/hasr1402/commentary.htm CDC: HIV/AIDS Surveillance Report, 2002, Commentary. 5. http://www.cdc.gov/hiv/stats/hasr1402/table8.htm CDC: HIV/AIDS Surveillance Report, 2002, Table 8. 6. http://www.cdc.gov/hiv/stats/hasr1402/table1.htm CDC: HIV/AIDS Surveillance Report, 2002, Table 1.