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MONDAY, Oct. 18 (HealthDayNews) -- An overhaul of federal guidelines for HIV prevention funding is drawing fire from AIDS activists, who fear that new regulations will water down effective programs that target gay men and minority groups.

But the U.S. Centers for Disease Control and Prevention, which is reviewing its rules, has also heard from critics who demand more accountability after federal funding for an extremely explicit AIDS prevention program in San Francisco was questioned.

In all, more than 4,700 people sent their opinions to the CDC during a two-month public review period that ended in August. The CDC had planned to issue new guidelines by the middle of December, regardless of the results of the presidential election, but the flood of comments may delay things, said agency spokeswoman Kathy Harben.

Advocates of the current system say there's no reason to launch a major overhaul of how the government pays for HIV prevention programs. "We find it ironic that in an administration that's trying to scale down red tape, there is this immense level of government interference happening here," said Dr. Tri Do, an assistant professor of medicine at the University of California at San Francisco and president-elect of the Gay & Lesbian Medical Association.

Currently, an organization that receives federal prevention funds -- say, a nonprofit AIDS advocacy group -- forms its own review panel to look over its use of the money. The CDC, which is spending $788 million this fiscal year on AIDS prevention, launched a review of the rules after controversy arose in 2001 over two programs offered by the Stop AIDS Project in San Francisco. The inspector general's office of the U.S. Department of Health and Human Services ruled that the programs -- titled "Booty Call" and "Great Sex Workshop" -- encouraged sexual activity and were obscene.

The Citizens Against Government Waste organization, among others, called the programs a misuse of money. But some AIDS advocates responded that their programs need to be explicit in order to reach their target audiences, which are often made up of sexually experienced gay men.

Harben said one purpose of the overhaul is to update the rules to reflect advances in technology, like the widespread use of the Internet. Also, "we wanted to increase the accountability of organizations that receive federal funds," she said.

Among the new proposals is a rule that would require state or local health officials to review HIV prevention programs to make sure they aren't obscene. Another controversial proposal states that federally funded education about sexually transmitted diseases will "contain medically accurate information regarding the effectiveness or lack of effectiveness of condoms."

In addition to fearing that the new rules could hush discussion of condoms, critics say the they will allow outsiders to dictate prevention techniques for groups of people they may know little about, including gay men and minorities.

Prevention programs targeted at blacks and Latinos, for example, should be reviewed by panels that include members of both ethnic groups, said George Ayala, director of the Institute for Gay Men's Health, based in New York City and San Francisco.

"The proposed guidelines offer no specificity around this issue," Ayala said, leading to potential problems regarding "cultural sensitivity, cultural relevance, and expertise around sexuality."

More information

Learn about the U.S. Centers for Disease Control and Prevention's strategy to combat AIDS.

(SOURCES: Kathy Harben, spokeswoman, U.S. Centers for Disease Control and Prevention, Atlanta; Tri Do, M.D., assistant professor of medicine, University of California, San Francisco; George Ayala, Psy.D., director, Institute for Gay Men's Health, New York)

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