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San Francisco's STOP AIDS Project, caught between the epidemic ravaging its sexually active gay clientele and a congressional backlash over its explicit programs, today faces a dilemma.
The program's directors must tone down their sexually explicit approach to prevention -- an approach previously vetted by experts at the Centers for Disease Control and Prevention and a local review panel -- or lose nearly $700,000 in federal money.
At issue are workshops offering guidelines for safe sex with male prostitutes, precautions for anal sex and information on safe oral sex, among others.
Because much of its money comes from the CDC, the program must comply with the Public Health Service Act's ban against encouraging sexual activity. Rep. Mark Souder, R-Ind., chairman of the House subcommittee that governs human resources, has demanded that the CDC demonstrate that these programs are scientifically sound and consistent with CDC guidelines for content.
In a letter Feb. 13, CDC Director Julie Gerberding notified Souder that the CDC and the Department of Health and Human Services Office of the Inspector General agreed that the workshops met both requirements. According to AIDS advocates, Souder wasn't satisfied and made his objections known to administration officials.
Souder could not be reached for comment. But committee aide Roland Foster said: ''If the program's working, where's the proof? Shouldn't there be some kind of yardstick we can hold up to see if it's working?''
The chairman's complaints apparently hit the mark, because the CDC did an about-face Friday in similar letters to STOP AIDS, to the San Francisco Department of Public Health and to Souder.
''We believe activities in which the STOP AIDS project engaged appear to violate . . . the Public Health Service Act,'' wrote Sandra Manning, director of the CDC's office of grants and procurement. She added that STOP AIDS must drop programs that ''directly promote and encourage sexual activity'' or lose federal money.
''The letter to STOP AIDS is clear,'' CDC spokesman Tom Skinner says. ''We give specific examples of apparent violations, including program titles that directly promote sexual activity, and that appears to violate the law.''
Foster called the reversal ''a great victory,'' adding ''the letter we got said (the CDC will) make sure that appropriate measures are in place to measure effectiveness. We are very happy about that.''
Shana Krochma of STOP AIDS counters that every STOP AIDS workshop has been approved by a local panel, as required by federal law. ''We haven't done anything wrong,'' she says.
''This sounds like someone in Washington saying your local standards are wrong, which is illogical,'' Krochma says. ''Who knows better than the people of San Francisco what they need from an HIV-prevention agency?''
Other AIDS advocates say the action threatens a keystone of AIDS prevention: To work, programs must be targeted to specific communities. Most of the growth of the epidemic over the past decade, they note, has occurred among minorities and women, groups that now account for more than half of the 40,000 new infections every year.
''This is the kind of thing that politicizes prevention,'' says Terje Anderson of the National Association of People with AIDS. ''It can have a chilling effect on organizations doing effective HIV work around the country.''
Gerberding acknowledged in April that prevention programs are inadequate and launched a new prevention initiative based on widespread HIV testing.
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