Too Many Americans are Still at Risk for HIV
HIV Prevention in the United States at a Critical Crossroads
The Status of HIV Prevention in the United States
science is clear: HIV prevention can and does save lives.1-4
Scores of scientific studies have identified effective
prevention interventions for numerous populations,5-10
and it is estimated that prevention efforts have averted more
HIV infections in the United States to date.4
In addition to the lives saved from HIV, it is estimated that
more than $125 billion in medical costs alone have been averted.11,12
the HIV crisis in America is far from over. CDC’s latest
estimates suggest that more than 56,000 Americans become
infected each year13—one
person every 9˝ minutes—and that more than one million people in
this country are now living with HIV.14
Far too many Americans remain at risk for HIV, especially
African Americans, Latinos, and gay and bisexual men of all
races. CDC estimates that roughly 1 in 5 people infected with
HIV in the United States is unaware of his or her infection and
may be unknowingly transmitting the virus to others.14
heavy burden of HIV in the United States is neither inevitable
nor acceptable. It is possible to end the U.S. epidemic, but
such an achievement will require that we dramatically expand
access to proven HIV prevention programs, make tough choices
about directing available resources, and effectively integrate
new HIV prevention approaches into existing programs.
Estimated Number of New HIV Infections and Persons Living with
Despite continued increases in the number of people living with
HIV/AIDS over time, and more opportunities for transmission, HIV
prevention efforts have helped to keep the number of new
conservative estimate examining the period 1991 to 2006.
imperative that we confront a serious threat to the health of
our nation. And that threat is complacency – a false sense of
security, a false sense of calm that hides what remains a
serious epidemic. The fact is that, right here in the United
States, every 9˝ minutes someone’s mother, someone’s daughter,
someone’s son, someone’s father, or friend, becomes infected
Director, CDC’s National Center for HIV/AIDS, Viral Hepatitis,
STD, and TB Prevention
Top of Page
HIV Prevention Works
almost three decades of experience with HIV in the United
States, we know that prevention works.
national investment in HIV prevention has contributed to
dramatic reductions in the annual number of new infections since
the peak of the epidemic in the mid 1980s, and an overall
stabilization of new infections over the past decade.13
Given continued increases in the number of people living with
HIV, this stabilization is in itself a sign of progress (see
the Success of Prevention”). Other important signs of
progress include dramatic declines in mother-to-child HIV
transmission and reductions in new infections among injection
drug users and heterosexuals over time.
prevention has also generated substantial economic benefits. For
every HIV infection that is prevented, an estimated $355,000 is
saved in the cost of providing lifetime HIV treatment,12
resulting in significant cost-savings for the health care
CDC’s Prevention Efforts
significant progress has been made, much more must be done. CDC
pursues three major strategies to reduce the toll of HIV in the
Supporting prevention programs.
CDC provides funding and technical assistance to help state and
local health departments and community-based organizations
implement evidence-based HIV prevention programs.
Tracking the epidemic.
CDC oversees surveillance systems to track new HIV infections
and HIV and AIDS diagnoses across the United States, as well as
the level of risk behaviors and access to prevention in
high-risk populations. This information helps ensure that
funding is directed to the populations and communities most in
Identifying new prevention interventions.
CDC works with research partners to identify and develop new
prevention interventions that address the specific needs of
populations at risk, so that they can be broadly disseminated
and integrated into local HIV prevention efforts.
Proven HIV Prevention Interventions
know more than ever before about what works to prevent HIV.
Research has led to a growing number of proven, cost-effective
approaches to reduce the risk of HIV infection. In the United
States, proven strategies include:
Learning one’s HIV status has been shown to result in
substantial reductions in risk behavior.15
Testing is a critical component of prevention efforts because
when people learn they are infected, they can take steps to
protect their own health and prevent HIV transmission to others.
Prevention programs for people living with HIV.
Individual and small-group interventions delivered by health
care providers, peers, and others have been shown to
significantly reduce risk behaviors among people who have been
diagnosed with HIV to help ensure they do not transmit the virus
To date, CDC has identified 10 proven interventions for
HIV-positive people that meet stringent criteria for efficacy
and scientific rigor.17
Prevention programs for people at risk of HIV infection.
Individual, small-group, and community interventions for people
who are at risk of HIV infection significantly reduce risk
behavior in diverse populations, including men who have sex with
heterosexual women and men, drug users, and youth.16
To date, CDC has identified 53 proven interventions for
populations at high risk that meet stringent criteria for
efficacy and scientific rigor.17
Partner services reduce the spread of HIV by facilitating the
confidential identification and notification of partners who may
have been unknowingly exposed to HIV, providing them with HIV
testing, and linking them to medical care, prevention programs,
and other services.18,19
Antiretroviral medications significantly reduce the risk of HIV
transmission from HIV-infected pregnant women to their infants20,21
and, when started promptly, can reduce the risk of infection
after exposure to HIV.22,23
Researchers are also studying whether antiretroviral medicines
given before risk behavior occurs can reduce the chances of
becoming infected with HIV24
more detailed discussion).
Substance abuse treatment.
Effective substance abuse treatment that helps drug users stop
injecting eliminates the risk of HIV transmission through
injection drug use and has been shown to reduce risky sexual
Access to condoms and sterile syringes.
In order for HIV prevention efforts to work, people who are
living with, or at risk for, HIV need to have access to
effective tools that enable them to reduce the risk of HIV
transmission. For example, research has shown that increasing
the availability of condoms27
and sterile syringes25
is associated with significant reductions in HIV risk.
Screening and treatment for other sexually transmitted
Sexually transmitted infections (STIs) increase an individual’s
risk of acquiring and transmitting HIV28,
and STI treatment may reduce HIV viral load.29,30,31
Therefore, STI screening and treatment may reduce risk for HIV
harsh mathematics of this epidemic proves that prevention is
essential to expanding treatment. Treatment without prevention
is simply unsustainable.”
Co-chair, Bill & Melinda Gates Foundation
term men who have sex with men is used in CDC surveillance
systems because it indicates the behaviors that transmit HIV
infection, rather than how individuals self-identify in terms of
Measuring the Success of Prevention: How Do You Count What
Trying to measure what does not occur – the number of infections
prevented, illness avoided, and lives saved – is a difficult
challenge in HIV prevention. Three key indicators can be used to
gauge the impact of HIV prevention efforts on the U.S. epidemic:
Trends in HIV infections.
Examining increases or decreases in estimated HIV infections
over time is an important indicator of overall prevention
progress, but may mask important signs of success. For example,
new HIV infections in the United States declined dramatically
after the mid-1980s, and overall have remained roughly stable
over the past decade.13
This stabilization, however, is an important sign of success.
With more people living with HIV than ever before thanks to
effective HIV medications,32
there are more opportunities for transmission. Yet the number of
infections has not increased, indicating that HIV testing,
prevention, and treatment programs are effectively reducing the
rate of transmission (see
A useful measure of prevention success is the estimated rate of
HIV transmission, which indicates the likelihood that an
HIV-infected individual will transmit the virus to others. CDC
estimates that there were 5 transmissions per 100 persons living
with HIV in the United States in 2006. This means that the vast
majority (at least 95%) of people living with HIV did not
transmit the virus to others that year. This represents an 89
percent decline in the estimated rate of HIV transmission since
Modeling of infections averted.
Scientists have developed models to estimate the number of HIV
infections that have been averted because of HIV prevention
efforts, based on the trajectory of the epidemic before
prevention programs were initiated. These models suggest that
hundreds of thousands of HIV infections have been prevented
because of the nation’s HIV prevention efforts.34
Despite substantial knowledge of how to effectively prevent HIV,
there is evidence that populations at greatest risk are not
being sufficiently reached by proven prevention interventions
and that Americans are becoming complacent about the threat of
many people at risk for HIV do not have access to HIV prevention
For example, 80 percent of gay and bisexual men report not being
reached by either individual- or group-based prevention programs
in the prior year.35
few people infected with HIV are aware of their infection.
CDC data indicate that roughly 1 in 5 people infected with HIV –
more than 200,000 individuals – do not know they have the virus.14
Because the majority of new sexually transmitted HIV infections
are transmitted by those unaware of their infection, undiagnosed
infection remains a significant factor fueling the HIV epidemic.36
many Americans have become complacent about HIV.
A recent survey by the Kaiser Family Foundation found that the
percentage of Americans who rank HIV as a major health problem
has declined precipitously over the past decade.37
Even more troubling are studies showing that some of the
populations with the highest rates of infection (including men
who have sex with men and African Americans) either do not
recognize their risk or believe HIV is no longer a serious
Estimates of New Infections, 2006, By Race/Ethnicity, Risk
Group, and Gender, for the Most Affected U.S. Subpopulations*
and bisexual men of all races and black heterosexuals account
for the greatest number of new HIV infections in the United
term men who have sex with men is used in CDC surveillance
systems because it indicates the behaviors that transmit HIV
infection, rather than how individuals self-identify in terms of
Populations at Greatest Risk
and bisexual men of all races and racial/ethnic minorities are
disproportionately affected by HIV, comprising the largest
number of new HIV infections, HIV and AIDS diagnoses, and deaths
among people with AIDS in the United States. Injection drug
users also remain at considerable risk, but new HIV infections
have been declining in this group.13
Men Who Have Sex with Men
HIV now affects a more diverse population than ever before, gay
and bisexual men of all races remain the group most severely and
disproportionately impacted by this epidemic.
transmission represents 53 percent of estimated new infections,
followed by transmission through heterosexual sex (31%) and
injection drug use (12%).13
is the only risk group in the United States in which infections
are increasing – the annual number of new infections has
increased steadily since the early 1990s.13
MSM continue to represent a greater number of new HIV infections
annually than any other population, followed closely by black
MSM – who are one of the most disproportionately affected
subgroups in the United States.39
addition to disparities by risk group, there are also severe
racial/ethnic disparities in the U.S. HIV epidemic, with blacks
bearing the heaviest burden. While prevention efforts have
helped maintain stability in the level of HIV infection among
blacks overall since the early 1990s,13
the ongoing toll in many black communities across the nation is
blacks represent 12 percent of the U.S. population, they account
for nearly half (45%) of new HIV infections.13
African Americans, black MSM are the hardest-hit subpopulation.39
Studies have found that almost 50 percent of black MSM are
infected in some cities.40
Heterosexual transmission also accounts for a substantial
proportion of the black HIV epidemic, with black women most
affected. Black heterosexual women represent 14 percent of all
new HIV infections in the United States, and black heterosexual
men account for 6 percent.39
women, the majority of whom are infected through heterosexual
sex, have an HIV infection rate that is nearly 15 times as high
as that of white women.39
not as severely impacted as blacks, Hispanics are also
disproportionately affected by HIV.
Hispanics represent approximately 13 percent of the U.S.
population, but account for 17 percent of all new HIV infections
in the United States each year. The overall HIV infection rate
for Hispanics is three times as high as that of whites (29.3 per
100,000 population versus 11.5).13
Hispanics, MSM are most heavily impacted, followed by women
need to be able to talk about HIV as we talk about jobs, as we
talk about housing, as we talk about civil rights. We all have a
responsibility to break the silence about this disease.”
Chair and President Emerita, National Council of Negro Women
Top of Page
What Will Determine the Future Course of the U.S. HIV Epidemic
Dramatically reducing HIV infection rates in the United States
will require a major new commitment to HIV prevention. The
future course of the U.S. HIV epidemic will be determined by the
scale of our response, and by how effectively we utilize proven
and emerging approaches to preventing HIV.
1. Scale of the Response
Research suggests that the size of the nation’s investment in
HIV prevention predicts future infection rates. Historically,
increases in federal investment in HIV prevention have been
followed by declines in infection rates.41
In recent years, federal resources have not been able to keep
pace with the epidemic. Since 2002, CDC’s HIV prevention budget
(approximately $750 million in FY09) has declined by almost 20
percent in real dollars (adjusted for inflation), and prevention
currently accounts for 4 percent of all federal HIV/AIDS
spending on the domestic epidemic.4,42,43
the request of Congress, CDC recently estimated the impact of
additional investment on the epidemic. These estimates projected
that with an additional $877 million in annual HIV prevention
funding, the reach of prevention programs could be significantly
expanded and transmission rates could be cut in half in just
over a decade, resulting in dramatic cost-savings and lives
It will take our collective investment—across all levels of
government and the private sector—to address the substantial
unmet HIV prevention need that has mounted in this country.
2. Making Tough Choices about Directing Available Resources
the population in need of prevention services has continued to
grow in the United States, CDC and the state and local partners
it funds have been forced to do
more with less. This has resulted in a “triage approach” to
public health, in which only the most urgent priorities can be
nation has been and will increasingly be required to make
difficult choices to ensure that available funds are having the
greatest impact on infection rates. Resources must be directed
to the populations at highest risk and to the strategies that
are most cost-effective in reducing HIV transmission. As a
nation, we must commit to using the best available science and
knowledge to guide decision-making at the national, state, and
is developing new tools to help determine the most effective
combination of HIV prevention interventions for specific
populations. These tools include:
surveillance systems and analyses.
CDC has developed innovative, technologically-advanced systems
to track new HIV infections, monitor HIV risk behaviors, and
measure access to effective interventions among high-risk
populations. CDC is also working to develop, for the first time,
estimates of HIV infection rates (cases per 100,000 population)
by individual risk group (e.g., men who have sex with men,
injection drug users, and high-risk heterosexuals). To date,
this information has only been available for population
subgroups assessed by the U.S. Census, such as men and women and
racial and ethnic groups. The new data will allow health
officials to more accurately estimate the health inequities
affecting specific subpopulations (e.g., black MSM), and direct
As data on the effectiveness and costs of a range of prevention
approaches continue to accumulate, CDC is developing
sophisticated models that will allow a more systematic and
precise examination of the cost-effectiveness of specific
approaches, help identify the best combination of available
interventions, and indicate the most effective allocation of
resources to reduce new infections nationally.
Analysis of state and local resource targeting.
CDC and other partners are currently analyzing how well federal,
state, and local resources are targeted to the geographic areas
and populations that bear the greatest burden of HIV. This
information will help HIV prevention planners determine what
changes may be necessary to ensure that resources are going
where they are needed most.
3. Integrating New HIV Prevention Tools into Existing Programs
existing prevention tools have had a significant impact on the
epidemic, there remains an urgent need for new prevention
options to reduce the burden of HIV in the United States. CDC,
the National Institutes of Health (NIH), and other research
partners are evaluating promising new biomedical and behavioral
approaches to HIV prevention.
new prevention interventions become available, it will be
critical to use them not in isolation, but in combination with
other proven interventions, especially since no single
behavioral or biomedical intervention is likely to be 100
percent effective against HIV infection. Biomedical and
behavioral interventions will need to be delivered in tandem to
ensure that all tools are maximized and avoid migration away
from more effective approaches.
number of promising clinical trials focusing on biomedical
strategies are likely to report results in the near future.
CDC, NIH, and other research groups are currently investigating
whether oral drugs used to treat HIV can be taken by
HIV-negative individuals to prevent them from becoming infected
with the virus. Known as pre-exposure prophylaxis (PrEP), this
strategy is being studied in clinical trials around the world.
Researchers are examining whether the application of vaginal
gels containing antiretroviral drugs can effectively prevent HIV
transmission during sex. Clinical trials to investigate the
effectiveness of several microbicide formulations in preventing
heterosexual HIV transmission to women are currently underway.
Intensified HIV testing, combined with early HIV treatment.
Because HIV-infected individuals taking antiretroviral
medications have lower levels of HIV in their blood than
untreated individuals, researchers are investigating whether
HIV-positive individuals in treatment are less likely than
untreated individuals to transmit HIV. CDC is supporting NIH in
research to evaluate the potential feasibility and impact of
expanded testing and treatment on prevention.
is also currently evaluating the potential role of adult male
circumcision in slowing the U.S. epidemic. This tool was
recently proven to reduce female-to-male transmission in African
settings. While there are important differences in the routes of
transmission and rates of circumcision in the United States and
Africa, there may be some subpopulations for whom this could
offer additional protection.
Moving forward, it will also be critical to identify effective
interventions to address the root societal factors facilitating
HIV transmission, including poverty, racism, and stigma.
Finally, we must maximize opportunities to address other serious
threats to health in those living with and at risk for HIV,
including viral hepatitis, other STDs, and tuberculosis.
the fight to conquer HIV, we stand at a critical crossroads.
Significant reductions in HIV are possible with a stronger
response to the HIV epidemic in the United States.
Unfortunately, without such a response, increases in new
infections are also possible. The future of the HIV epidemic
will depend on the choices we make today.
nation, now is the time to determine the direction we will take
in fighting this serious – yet preventable – disease. One
direction leads to complacency and the injustice of an HIV
epidemic that affects the most vulnerable of Americans. The
other turns toward a re-energized, science-driven effort to
reduce the spread of HIV. Public health and our national
conscience require we make the right choice.”
Director, CDC’s Division of HIV/AIDS Prevention
Top of Page
Institute of Medicine. No time to lose: getting more for
HIV prevention. Washington, D.C.: National Academy Press;
National Institutes of Health. Interventions to prevent
HIV risk behaviors. NIH consensus statement 1997;15(2):1-41.
UNAIDS. HIV prevention needs and successes: a tale of
three countries. Geneva, Switzerland: Joint United Nations
Programme on HIV/AIDS; 2001.
Written testimony on HIV/AIDS
incidence and prevention for the U.S. House of Representatives
Committee on Oversight and Government Reform . September 16,
2008. (Accessed July 8, 2009)
Wolitski RJ, Janssen RS, Holtgrave DR, et al. The public
health response to the HIV epidemic in the U.S. In: Wormser GP,
editor. AIDS and other manifestations of HIV infection. 4th ed.
San Diego, CA: Elsevier Academic Press; 2004:997-1012.
Herbst JH, Sherba RT, Crepaz N, et al. A meta-analytic
review of HIV behavioral interventions for reducing sexual risk
behavior of men who have sex with men. J Acquir Immune Defic
Mullen PD, Ramirez G, Strouse D, et al. Meta-analysis of
the effects of behavioral HIV prevention interventions on the
sexual risk behavior of sexually experienced adolescents in
controlled studies in the United States. J Acquir Immune
Defic Syndr 2002;30(Suppl 1):S94-S105.
Neumann MS, Johnson WD, Semaan S, et al. Review and
meta-analysis of HIV prevention intervention research for
heterosexual adult populations in the United States. J Acquir
Immune Defic Syndr 2002;30(Suppl 1):S106-S117.
Semaan S, DesJarlais DC, Sogolow E, et al. A
meta-analysis of the effect of HIV prevention interventions on
the sex behaviors of drug users in the United States. J
Acquir Immune Defic Syndr 2002;30(Suppl 1):S73-S93.
Crepaz N, Lyles CM, Wolitski RJ, et al. Do prevention
interventions reduce HIV risk behaviours among people living
with HIV? A meta-analytic review of controlled trials. AIDS
Holtgrave DR, Pinkerton SD. Updates of cost of illness
and quality of life estimates for use in economic evaluations of
HIV prevention programs. J Acquir Immune Defic Syndr
Schackman BR, Gebo KA, Walensky RP, et al. The lifetime
cost of current human immunodeficiency virus care in the United
States. Med Care 2006 Nov;44(11):990-97.
Hall HI, Song R, Rhodes P, et al. Estimation of HIV
incidence in the United States. JAMA 2008;300(5):520-529.
HIV prevalence estimates—United
States, 2006. MMWR 2008; 57(39):1073-76.
Weinhardt LS, Carey MP, Johnson BT, et al. Effects of HIV
counseling and testing on sexual risk behavior: a meta-analytic
review of published research, 1985-1997. Am J Public Health
Evolution of HIV/AIDS prevention
programs—United States, 1981–2006. MMWR
2008 compendium of evidence-based HIV
prevention interventions. (Accessed July 8, 2009)
Hogben M, McNally T, McPheeters M, et al. The
effectiveness of HIV partner counseling and referral services in
increasing identification of HIV-positive individuals: a
systematic review. Am J Prev Med 2007; 33(2
Recommendations for partner services
programs for HIV infections, syphilis, gonorrhea, and chlamydial
infection. MMWR 2008;57(No. RR9):1-83.
Connor EM, Sperling RS, Gelber R, et al. Reduction of
maternal-infant transmission of human immunodeficiency virus
type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials
Group Protocol 076 Study Group. N Engl J Med
Perinatal HIV Guidelines Working Group.
Public health service task force
recommendations for use of antiretroviral drugs in pregnant
HIV-infected women for maternal health and interventions to
reduce perinatal HIV transmission in the United States . April 29,
2009; pp 1-90. (Accessed July 8, 2009)
Case-control study of HIV
seroconversion in health-care workers after percutaneous
exposure to HIV-infected blood—France, United Kingdom, and
United States, January 1988-August 1994. MMWR
prophylaxis after sexual, injection-drug use, or other
nonoccupational exposure to HIV in the United States:
recommendations from the U.S. Department of Health and Human
Services. MMWR 2005;54(No. RR-2):1-20.
Cohen MS, Gay C, Kashuba AD, et al. Antiretroviral
therapy to prevent the sexual transmission of HIV-1. Ann Intern
Med 2007 Apr 17;146(8):591601.
Fuller CM, Ford C, Rudolph A. Injection drug use and HIV:
past and future considerations for HIV prevention and
interventions. In: Mayer KH, Pizer HF, editors. HIV prevention:
a comprehensive approach. London: Academic Press/Elsevier;
Drumright LN, Colfax GN. HIV risk and prevention for
non-injection substance users. In: Mayer KH, Pizer HF, editors.
HIV prevention: a comprehensive approach. London: Academic
Cohen DA , Farley TA, Bedimo-Etame JR, et al.
Implementation of condom social marketing in Louisiana, 1993 to
1996. Am J Public Health 1999;89:204-8.
Fleming DT, Wasserheit JN. From epidemiological synergy
to public health policy and practice: the contribution of other
sexually transmitted disease to sexual transmission of HIV
infection. Sex Transm Infect 1999;75(1):3-17.
Baeten JM, Strick LB, Lucchetti A, et al. Herpes simplex
virus (HSV)-suppressive therapy decreases plasma and genital
HIV-1 levels in HSV-2/HIV-1 coinfected women: a randomized,
placebo-controlled, cross-over trial. J Infect Dis 2008
Zuckerman RA, Lucchetti A, Whittington WL, et al. Herpes
simplex virus (HSV) suppression with valacyclovir reduces rectal
and blood plasma HIV-1 levels in HIV-1/HSV-2-seropositive men: a
randomized, double-blind, placebo-controlled crossover trial.
J Infect Dis 2007 Nov 15;196(10):1500-8.
Dunne EF, Whitehead S, Sternberg M, et al. Suppressive
acyclovir therapy reduces HIV cervicovaginal shedding in HIV-and
HSV-2-infected women, Chiang Rai, Thailand. J Acquir Immune
Defic Syndr 2008 Sep 1;49(1):77-83.
Campsmith M, Rhodes P, Hall HI.
Estimated prevalence of undiagnosed
HIV infection in the United States at the end of 2006. Presented
at the 16th Conference on Retroviruses and Opportunistic
Infections . Montreal,
Canada. February 11, 2009. (Accessed July 8, 2009)
Holtgrave DR, Hall HI, Rhodes PH, et al. Updated annual
HIV transmission rates in the United States, 1977-2006. J
Aquir Immune Defic Syndr 2009;50(2):236-238.
Holtgrave DR. Estimating the effectiveness and efficiency
of U.S. HIV prevention efforts using scenario and
cost-effectiveness analysis. AIDS 2002 Nov
Human immunodeficiency virus (HIV)
risk, prevention, and testing behaviors—United States, national
HIV behavioral surveillance system: men who have sex with men,
November 2003–April 2005. Surveillance Summaries, July 2006.
MMWR 2006;55(No. SS-6):1-16.
Marks G, Crepaz N, Janssen RS. Estimating sexual
transmission of HIV from persons aware and unaware that they are
infected with the virus in the USA. AIDS 2006 Jun
Kaiser Family Foundation.
2009 Survey of Americans on HIV/AIDS:
summary of findings on the domestic epidemic . April 2009. (Accessed
July 8, 2009)
MacKellar DA, Valleroy LA, Secura GM, et al. Perceptions
of lifetime risk and actual risk for acquiring HIV among young
men who have sex with men. AIDS Behav 2007
Subpopulation estimates from the HIV
incidence surveillance system—United States, 2006.
HIV prevalence, unrecognized
infection, and HIV testing among men who have sex with men—five
U.S. cities, June 2004–April 2005. MMWR
Holtgrave DR, Kates J. HIV incidence and CDC’s HIV
prevention budget: an exploratory correlational analysis. Am
J Prev Med 2007;32(1):63-67.
Holtgrave DR. When “heightened” means “lessened”: the
case of HIV prevention resources in the United States. J
Urban Health 2007 Sep; 84(5):648-652.
Kaiser Family Foundation.
U.S. federal funding for HIV/AIDS:
the FY 2009 budget request . April 2008. (Accessed
July 8, 2009)
CDC. Professional Judgment Budget.
Prepared for the U.S. House of
Representatives Committee on Oversight and Government Reform . September 16,
2008. (Accessed July 8, 2009)