NAPWA salutes President Obama and the White House Office of National AIDS Policy, directed by NAPWA alumnus Jeff Crowley, for their July 13, 2010 announcement of this country's first-ever National HIV/AIDS Strategy. The strategy has three goals:

• Reducing  the number of new infections.
• Increasing access to care and optimizing health outcomes for people living with HIV.
• Reducing HIV-related health disparities.

(Click HERE to visit the White House website for an outline of the policy. And click HERE to watch the President's remarks.)

Our Vice President for Public Policy Matt Lesieur joined our Positive Voice newlsetter a few days later, to tell us what the new strategy means and what all of us in the HIV community have to help make happen.

• What does the National AIDS Strategy Mean for the United States?
• Reducing New HIV infections
• Increasing Access to Care and Improving Health Outcomes for People Living with HIV
• Reducing HIV-Related Health Disparities
• Major gap: no new money

What does the National AIDS Strategy Mean for the United States?
By Matt Lesieur, NAPWA Vice President for Public Policy

As you have just read, on Tuesday, July 13, 2010 the Obama Administration released the nation’s first national strategy to address the domestic HIV epidemic. It is the first time that the United States government has attempted to take a comprehensive approach at addressing HIV in the U.S. The federal government spends more than $17 billion a year on the domestic HIV epidemic, yet the allocation of those funds is determined by a variety of uncoordinated federal laws, policies and programs, as well as state and local decision-making processes. Most HIV programs exist in silos, with poor coordination among agencies and little effort at maximizing the usage of existing resources and creating efficiencies. The National AIDS Strategy is a first step towards turning that around.

Until now, most government approaches to HIV have been looked at through the prism of particular funding streams, such as Ryan White, HOPWA or Medicaid, to name a few. The National AIDS Strategy (NHAS) actually looks at the epidemic in a whole new way, not by funding stream or a particular federal agency, but at what the needs are of the HIV epidemic overall, and then assigns particular agencies with tasks to address those needs. The strategy also takes a look at particular populations that are disproportionately impacted by the HIV epidemic, such as black and Latino gay men, with a goal of focusing attention and resources on those communities.

Overall, the strategy has four main goals:
1.    Reduce new HIV infections
2.    Increase access to care and improve health outcomes of persons living with HIV
3.    Reduce HIV-related disparities and health inequities
In addition, a fourth goal is listed as an important theme of the strategy:
4.    Achieve a more coordinated national response to the HIV epidemic

Within each goal, the government set standards by which to measure its success in reaching that goal. For example, one of the measures of the second goal, to increase access to care, is “By 2015, increase the proportion of newly diagnosed patients linked to clinical care within three months of their HIV diagnosis from 65 percent to 85 percent.” That is a pretty clear and concrete measure by which the public and government can look at and ask ourselves “Did we do what we set out to do?”

The federal government has established benchmark measures for each goal. They are as follows:

(1) Reducing New HIV infections
• By 2015, lower the annual number of new infections by 25 percent (from 56,300 to 42,225).
• Reduce the HIV transmission rate, which is a measure of annual transmissions in relation to the number of people living with HIV, by 30 percent (from 5 persons infected per 100 people with HIV to 3.5 persons infected per 100 people with HIV).
• By 2015, increase from 79 percent to 90 percent the percentage of people living with HIV who know their serostatus (from 948,000 to 1,080,000 people).

(2) Increasing Access to Care and Improving Health Outcomes for People Living with HIV
• By 2015, increase the proportion of newly diagnosed patients linked to clinical care within three months of their HIV diagnosis from 65% to 85% (from 26,824 to 35,078 people).
• By 2015,increase the proportion of Ryan White HIV/AIDS Program clients who are in continuous care (at least 2 visits for routine HIV medical care in 12 months at least 3 months apart) from 73 percent to 80 percent (or 237,924 people in continuous care to 260,739 people in continuous care).
• By 2015, increase the number of Ryan White clients with permanent housing from 82 percent to 86 percent (from 434,000 to 455,800 people). (This serves as a measurable proxy of our efforts to expand access to HUD and other housing supports to all needy people living with HIV.)

(3) Reducing HIV-Related Health Disparities
While working to improve access to prevention and care services for all Americans,
• By 2015, increase the proportion of HIV diagnosed gay and bisexual men with undetectable viral load by 20 percent.
• By 2015, increase the proportion of HIV diagnosed Blacks with undetectable viral load by 20 percent.
• By 2015, increase the proportion of HIV diagnosed Latinos with undetectable viral load by 20 percent.

In the first goal, reducing new HIV infections, the Strategy focuses a great deal on re-orienting efforts by giving more attention and resources to populations at greatest risk for HIV. In particular, those populations they note are: gay and bisexual men, black men and women, Latinos and Latinas and substance users. The Strategy calls for greater intensity in HIV prevention efforts in communities where HIV is heavily concentrated. The plan wisely notes that “Not every person or group has an equal chance of becoming infected with HIV. Yet, for many years, too much of our Nation’s response has been conducted as though everyone is equally at risk for HIV infection.”

The second goal, increasing access to care and improving health outcomes for PLWHAs, does rely heavily on the recently passed health care reform law. Many provisions of health care reform, such as the huge expansion of Medicaid, the creation of state based health insurance exchanges, and the ban on certain industry practices, will all immensely benefit the HIV population. With that assumption, the Strategy talks about taking steps to increase the number of HIV clinical care providers and supporting the complex and challenging needs of PLWHAs such as housing and other barriers that can reduce access to HIV care.

In the third goal, reducing HIV related health disparities, the Obama Administration recognized the strong relationship between HIV stigma and disparities in care, treatment and prevention. One of the important steps the Strategy recognizes is the need to reduce stigma and discrimination against people living with HIV. It also talks about taking steps to measure and reduce community viral load, promoting a more holistic approach to health, and ensuring that high-risk groups have access to regular viral load and CD4 tests. Community level approaches to reduce HIV infection in high risk communities must be adopted.

Major gap: no new money

NAPWA is extremely pleased and grateful that the Obama Administration worked hard on developing and releasing a National AIDS Strategy. Jeff Crowley, Director of the Office of National AIDS Policy, must be given credit for all this effort. It is an extremely well thought out document that does take a comprehensive, holistic approach to the HIV epidemic in the United States. What is missing from all this, however, is any commitment of new federal resources.

The current ADAP crisis, with 2,300 -- and climbing -- on waiting lists for HIV medications shows what happens when insufficient resources are dedicated to a critical program. This Strategy will have limited meaning if at the end of the day the very basic needs of PLWHAs are unmet. Much of this Strategy focuses on identifying more individuals living with HIV who are unaware of their status and ensuring that everyone with HIV has access to HIV care. An ADAP waiting list is completely contradictory to those key goals. While we all have a responsibility to ensuring that the NHAS is a success, we must not lose sight of the most important goal in all of what we do -- keeping PLWHAs alive and healthy.

The release of the National AIDS Strategy is a bold first step. Now, the Administration, Congress and the HIV community must work together to ensure that the goals and objectives of this strategy are met.

Click HERE to download the National HIV/AIDS Strategy.

Click HERE to follow community dialogue on the Strategy.