White House Releases Long-awaited National AIDS Strategy

		SUMMARY: On Tuesday, July 13, President Barack Obama unveiled the first-ever National HIV/AIDS Strategy for the United States. The plan, developed over the past year and a half in consultation with stake-holders across the country, espouses important goals -- including allocation of resources to the most heavily affected groups, science-based approaches, and greater coordination of prevention, testing, and care -- but advocates decried the absence of new funding for its implementation.

By Liz Highleyman

Obama unveiled the strategy and its accompanying federal implementation plan at White House press conference, followed by a reception for members of the HIV/AIDS community.

"[W]e have learned what we can do to stop the spread of the disease. We've learned what we can do to extend the lives of people living with it," he said. "So the question is not whether we know what to do, but whether we will do it."

Over the last 15 months, the White House Office of National AIDS Policy (ONAP) hosted 14 public community discussions totalling upwards of 4000 participants and collected more than 1000 comments through its website. Input came from medical and social science experts, AIDS care and service providers, and people with HIV and their advocates from across the country.

"This represents the work of thousands of individuals whose leadership and input over the last three years helped it take shape," said Judith Auerbach of the San Francisco AIDS Foundation who helped found the Coalition for a National AIDS Strategy. "Now it is up to all of us to ensure its full funding and implementation and hold our government accountable for progress."

The National HIV/AIDS Strategy (NHAS) vision statement reads, "The United States will become a place where new HIV infections are rare, and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity, or socio-economic circumstance will have unfettered access to high-quality, life-extending care, free from stigma and discrimination."

The three key goals are to reduce the number of new infections, increase access to care, and reduce HIV-related health disparities. Other components of the plan include establishing a seamless system to link newly diagnosed individuals with coordinated care, increasing the number of healthcare providers, and supporting people with co-existing problems such as homelessness.

As a first step, the White House issued a memorandum asking federal agencies -- including Health and Human Services, the Centers for Disease Control and Prevention (CDC), the Department of Labor, Housing and Urban Development, Veterans Affairs, and the Social Security Administration -- to develop plans to implement the strategy within 150 days.

Matching Resources to Needs

More than 1 million people are currently living with HIV -- including an estimated 20 percent who do not know they are infected -- and approximately 56,000 are newly infected each year.

The NHAS aims to accomplish the following goals:

	Reduce the number of new HIV infections by 25%;
	Lower the rate of HIV transmission by 30%;
	Increase the number of infected people who know their status by nearly 10%;
	Raise the number of people accessing care within 3 months of diagnosis by 30%;
	Increase the proportion of gay/bisexual men, blacks, and Latinos with undetectable viral load by 20%.

A key theme of the strategy is allocating resources where the need is greatest. While gay and bisexual men make up only a small percentage of the U.S. population, they account for more than half of all new HIV infections.

"After 29 years of neglect, gay and bisexual men are finally being given the attention they deserve," said Jim Pickett of the AIDS Foundation of Chicago.

Similarly, black people make up about 13% of the population but account for nearly half of people living with HIV; Latinos also have a higher rate of HIV infection compared with whites.

At the White House press conference, Health and Human Services Secretary Kathleen Sebelius noted, "If you're a white, heterosexual woman like me, your chances of being infected by HIV/AIDS are very low -- just 1 in 50,000. But if you're a black female who's an injection drug user, your chances of being infected are more than 1000 times higher -- closer to 1 in 35."

The new strategy embraces a comprehensive approach to linking prevention, testing, and care -- though not necessarily immediate antiretroviral therapy. It comes amid a growing debate about the public health and civil rights implications of promoting earlier treatment as a means of prevention.

"Ensuring that people with HIV disease are diagnosed early and linked to lifesaving medical care is central to the president's strategy," said Michael Saag, chair of the HIV Medicine Association. "A renewed focus on patient care is urgently needed to meet the increased demand for HIV care, which will grow under this effort."

HIV/AIDS advocates generally applauded the NHAS goals, but many criticized the lack of any major new funding for implementation. Instead, resources will be re-allocated from existing programs. Fro example, Obama pledged $30 million for HIV prevention and education from funds allocated for the Patient Protection and Affordable Care Act (the recent healthcare reform legislation).

"This strategy is a day late and a dollar short," said Michael Weinstein of the AIDS Healthcare Foundation. "Fifteen months in the making, and the White House learned what people in the field have known for years. There is no funding, no 'how to,' no real leadership."

Advocates have also been critical of the growing shortfalls facing AIDS Drug Assistance Programs (ADAPs). According to the July 9, 2010 edition of the National Alliance of State and Territorial AIDS Directors (NASTAD) ADAP Watch, there are now 2291 people on waiting lists in 12 states. The administration this month allocated an additional $25 million for the program, but activists said the need is closer to $125 million.

"It is imperative that this nation has a comprehensive approach to HIV care and prevention," said Randy Allgaier, a member of the Coalition for a National AIDS Strategy. "The current ADAP crisis is a prime example of what is wrong with our current response to HIV/AIDS; it is fragmented and seems to move from crisis to crisis rather than to think strategically."

The National HIV/AIDS Strategy for the United States and accompanying materials are available online at www.aids.gov/federal-resources/policies/national-hiv-aids-strategy.

7/16/10

Sources

National HIV/AIDS Strategy for the United States. July 2010.

White House Office of National AIDS Policy. White House Announces National HIV/AIDS Strategy. Press release. July 13, 2010.

AIDS Healthcare Foundation. AHF to Criticize WH Strategy in Face of Administration's Ongoing Indifference to Domestic & Global AIDS Epidemic. Press release. July 12, 2010.

HIV Medicine Association. HIV Care Providers and Researchers Applaud Release of National HIV/AIDS Strategy. Press release. July 13, 2010.

San Francisco AIDS Foundation. National HIV/AIDS Strategy Can Lead to Dramatic Progress in Domestic Response to HIV/AIDS. Press release. July 13, 2010.

NASTAD. ADAP Watch. July 9, 2010.