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MEDICAL: DISEASES: AIDS HIV ACQUIRED IMMUNE DEFICIENCY :
UNITED STATES: GOVERNMENT:
National HIV/AIDS Strategy:
Coordinated by the White House Office of National AIDS Policy




National HIV/AIDS Strategy:
Coordinated by the White House Office of National AIDS Policy
Executive Summary
<http://aids.gov/federal-resources/policies/
national-hiv-aids-strategy/executive-summary/index.html>



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Implementation plan
<http://aids.gov/federal-resources/policies/
national-hiv-aids-strategy/nhas-implementation.pdf>


Additional information
<http://aids.gov/federal-resources/policies/national-hiv-aids-strategy/>



Executive Summary




When one of our fellow citizens becomes infected with the human
immunodeficiency virus (HIV) every nine-and-half minutes, the epidemic
affects all Americans. It has been nearly thirty years since the first
cases of HIV garnered the worlds attention. Without treatment, the virus
slowly debilitates a persons immune system until they succumb to illness.
The epidemic has claimed the lives of nearly 600,000 Americans and affects
many more.1 Our nation is at a crossroads. We have the knowledge and tools
needed to slow the spread of HIV infection and improve the health of
people living with HIV. Despite this potential, however, the publics sense
of urgency associated with combating the epidemic appears to be declining.
In 1995, 44% of the general public indicated that HIV/AIDS was the most
urgent health problem facing the Nation, compared to only 6% in March
2009.2 While HIV transmission rates have been reduced substantially over
time and people with HIV are living longer and more productive lives,
approximately 56,000 people become infected each year and more Americans
are living with HIV than ever before.34 Unless we take bold actions, we
face a new era of rising infections, greater challenges in serving people
living with HIV, and higher health care costs.5


President Obama committed to developing a National HIV/AIDS Strategy with
three primary goals: 1) reducing the number of people who become infected
with HIV, 2) increasing access to care and optimizing health outcomes for
people living with HIV, and 3) reducing HIV-related health disparities. To
accomplish these goals, we must undertake a more coordinated national
response to the HIV epidemic. The Strategy is intended to be a concise
plan that will identify a set of priorities and strategic action steps
tied to measurable outcomes. Accompanying the Strategy is a Federal
Implementation Plan that outlines the specific steps to be taken by
various Federal agencies to support the high-level priorities outlined in
the Strategy. This is an ambitious plan that will challenge us to meet all
of the goals that we set. The job, however, does not fall to the Federal
government alone, nor should it. Success will require the commitment of
all parts of society, including State, tribal and local governments,
businesses, faith communities, philanthropy, the scientific and medical
communities, educational institutions, people living with HIV, and others.
The vision for the National HIV/AIDS Strategy is simple:


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.



Reducing New HIV Infections



More must be done to ensure that new prevention methods are identified and
that prevention resources are more strategically concentrated in specific
communities at high risk for HIV infection. Almost half of all Americans
know someone living with HIV (43% in 2009).6 Our national commitment to
ending the HIV epidemic, however, cannot be tied only to our own
perception of how closely HIV affects us personally. Just as we mobilize
the country to support cancer prevention and research whether or not we
believe that we are at high risk of cancer, or just as we support
investments in public education whether or not we have children, success
at fighting HIV calls on all Americans to help us sustain a long-term
effort against HIV. While anyone can become infected with HIV, some
Americans are at greater risk than others. This includes gay and bisexual
men of all races and ethnicities, Black men and women, Latinos and
Latinas, people struggling with addiction, including injection drug users,
and people in geographic hot spots, including the U.S. South and
Northeast, as well as Puerto Rico and the U.S. Virgin Islands. By focusing
our efforts in communities where HIV is concentrated, we can have the
biggest impact in lowering all communities collective risk of acquiring
HIV.


We must also move away from thinking that one approach to HIV prevention
will work, whether it is condoms, pills, or information. Instead, we need
to develop, evaluate, and implement effective prevention strategies and
combinations of approaches including efforts such as expanded HIV testing
(since people who know their status are less likely to transmit HIV),
education and support to encourage people to reduce risky behaviors, the
strategic use of medications and biomedical interventions (which have
allowed us, for example, to nearly eliminate HIV transmission to
newborns), the development of vaccines and microbicides, and the expansion
of evidence-based mental health and substance abuse prevention and
treatment programs. It is essential that all Americans have access to a
shared base of factual information about HIV. The Strategy also provides
an opportunity for working together to advance a public health approach to
sexual health that includes HIV prevention as one component. To
successfully reduce the number of new HIV infections, there must be a
concerted effort by the public and private sectors, including government
at all levels, individuals, and communities, to:




Intensify HIV prevention efforts in communities where HIV is most heavily
concentrated.


Expand targeted efforts to prevent HIV infection using a combination of
effective, evidence-based approaches.


Educate all Americans about the threat of HIV and how to prevent it.
Increasing Access to Care and Improving Health Outcomes for People Living
with HIV




As a result of our ongoing investments in research and years of clinical
experience, people living with HIV can enjoy long and healthy lives. To
make this a reality for everyone, it is important to get people with HIV
into care early after infection to protect their health and reduce their
potential of transmitting the virus to others. For these reasons, it is
important that all people living with HIV are well supported in a regular
system of care. The Affordable Care Act, which will greatly expand access
to insurance coverage for people living with HIV, will provide a platform
for improvements in health care coverage and quality. High risk pools are
available immediately. High risk pools will be established in every state
to provide coverage to uninsured people with chronic conditions. In 2014,
Medicaid will be expanded to all lower income individuals (below 133% of
the Federal poverty level, or about $15,000 for a single individual in
2010) under age 65. Uninsured people with incomes up to 400% of the


Federal poverty level (about $43,000 for a single individual in 2010) will
have access to Federal tax credits and the opportunity to purchase private
insurance coverage through competitive insurance exchanges. New consumer
protections will better protect people with private insurance coverage by
ending discrimination based on health status and pre-existing conditions.
Gaps in essential care and services for people living with HIV will
continue to need to be addressed along with the unique biological,
psychological, and social effects of living with HIV. Therefore, the Ryan
White HIV/AIDS Program and other Federal and State HIV-focused programs
will continue to be necessary after the law is implemented. Additionally,
improving health outcomes requires continued investments in research to
develop safer, cheaper, and more effective treatments. Both public and
private sector entities must take the following steps to improve service
delivery for people living with HIV:




Establish a seamless system to immediately link people to continuous and
coordinated quality care when they are diagnosed with HIV.

Take deliberate steps to increase the number and diversity of available
providers of clinical care and related services for people living with
HIV.


Support people living with HIV with cooccurring health conditions and
those who have challenges meeting their basic needs, such as housing.


Reducing HIVRelated Health Disparities



The stigma associated with HIV remains extremely high and fear of
discrimination causes some Americans to avoid learning their HIV status,
disclosing their status, or accessing medical care.7 Data indicate that
HIV disproportionately affects the most vulnerable in our societythose
Americans who have less access to prevention and treatment services and,
as a result, often have poorer health outcomes. Further, in some heavily
affected communities, HIV may not be viewed as a primary concern, such as
in communities experiencing problems with crime, unemployment, lack of
housing, and other pressing issues. Therefore, to successfully address
HIV, we need more and better communitylevel approaches that integrate HIV
prevention and care with more comprehensive responses to social service
needs. Key steps for the public and private sector to take to reduce
HIV-related health disparities are:




Reduce HIV-related mortality in communities at high risk for HIV
infection.


Adopt community-level approaches to reduce HIV infection in high-risk
communities.


Reduce stigma and discrimination against people living with HIV.
Achieving a More Coordinated National Response to the HIV Epidemic in the
United States



The Nation can succeed at meeting the Presidents goals. It will require
the Federal government and State, tribal and local governments, however,
to do some things differently. Foremost is the need for an unprecedented
commitment to collaboration, efficiency, and innovation. We also must be
prepared to adjust course as needed. This Strategy is intended to
complement other related efforts across the Administration. For example,
the Presidents Emergency Plan for AIDS Relief (PEPFAR) has taught us
valuable lessons about fighting HIV and scaling up efforts around the
world that can be applied to the domestic epidemic. The Presidents


National Drug Control Strategy serves as a blueprint for reducing drug use
and its consequences, and the Federal Strategic Plan to Prevent and End
Homelessness focuses efforts to reduce homelessness and increase housing
security. ONAP will work collaboratively with the Office of National Drug
Control Policy and other White House offices, as well as relevant agencies
to further the goals of the Strategy. The Strategy is intended to promote
greater investment in HIV/AIDS, but this is not a budget document.


Nonetheless, it will inform the Federal budget development process within
the context of the fiscal goals that the President has articulated. The
U.S. currently provides more than $19 billion in annual funding for
domestic HIV prevention, care, and research, and there are constraints on
the magnitude of any potential new investments in the Federal budget. The
Strategy should be used to refocus our existing efforts and deliver better
results to the American people within current funding levels, as well as
highlight the need for additional investments. Our national progress will
require sustaining broader public commitment to HIV, and this calls for
more regular communications to ensure transparency about whether we are
meeting national goals. Key steps are to:


Increase the coordination of HIV programs across the Federal government
and between federal agencies and state, territorial, tribal, and local
governments.


Develop improved mechanisms to monitor and report on progress toward
achieving national goals.


This Strategy provides a basic framework for moving forward. With
government at all levels doing its part, a committed private sector, and
leadership from people living with HIV and affected communities, the U.S.
can dramatically reduce HIV transmission and better support people living
with HIV and their families.



Table of Contents


Executive Summary


Introduction


Reducing New HIV Infections


Step 1: Intensify HIV prevention efforts in the communities where HIV is
most heavily concentrated


Step 2: Expand targeted efforts to prevent HIV infection using a
combination of effective, evidence-based approaches


Step 3: Educate all Americans about the threat of HIV and how to prevent
it


Increasing Access to Care and Improving Health Outcomes for People Living
with HIV


Step 1: Establish a seamless system to immediately link people to
continuous and coordinated quality care when they learn they are infected
with HIV


Step 2: Take deliberate steps to increase the number and diversity of
available providers of clinical care and related services for people
living with HIV


Step 3: Support people living with HIV with co-occurring health conditions
and those who have challenges meeting their basic needs, such as housing


Reducing HIV-Related Disparities and Health Inequities


Step 1: Reduce HIV-related mortality in communities at high risk for HIV
infection


Step 2: Adopt community-level approaches to reduce HIV infection in
high-risk communities.


Step 3: Reduce stigma and discrimination against people living with HIV


Achieving a More Coordinated National Response to the HIV Epidemic


Step 1: Increase the coordination of HIV programs across the Federal
government and between federal agencies and state, territorial, tribal,
and local governments


Step 2: Develop improved mechanisms to monitor and report on progress
toward achieving national goals


Conclusion




Implementation Strategy


Introduction
President Obama committed to developing a National HIV/AIDS Strategy with
three primary goals:



1) reducing the number of people who become infected with HIV,



2) increasing access to care and optimizing health outcomes for people
living with HIV, and 3) reducing HIV-related health disparities. To
accomplish these goals, we must undertake a more coordinated, vigorous
national response to the HIV epidemic.



The President also promised that the Strategy would rely on sound science
and include measurable goals, timelines, and accountability mechanisms.


This document is a companion to the National HIV/AIDS Strategy for the
United States. It presents the Administrations plan for measuring progress
toward meeting the Strategys goals, and includes immediate and short-term
Federal actions (those that can be achieved in calendar years 2010 and
2011) that will move the Nation toward improving its response to
HIV/AIDS.1 Where appropriate, we have highlighted some longer-term
actions, but our immediate emphasis has been on identifying initial steps
for moving forward. In 2011, ONAP will consult with Federal agencies to
develop specific actions for 2012, and the plan will be updated annually,
thereafter. This is a living documentwe will evaluate our progress and
modify it as necessary as we achieve certain milestones or experience
unanticipated setbacks. Additionally, as the Federal agencies do their
work to implement the Strategy, we anticipate that new activities will
also be developed.


The job of implementing the National HIV/AIDS Strategy, however, does not
fall to the Federal Government alone, nor should it. The success of the
Strategy will require States, tribal and local governments, communities,
and other partners to work together to better coordinate their responses
to HIV/AIDS at the State and local levels. Therefore, we hope that the
strategy will serve as a catalyst for all levels of government and other
stakeholders to develop their own implementation plans for achieving the
goals of the National HIV/AIDS Strategy.


The vision for the National HIV/AIDS Strategy is simple:


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.


1. The National HIV/AIDS Strategy for the United States and the National
HIV/AIDS Strategy: Federal Implementation Plan are available at
www.WhiteHouse.gov/ONAP.



Key Steps in Implementing the Strategy



The National HIV/AIDS Strategy is just a collection of words on paper,
unless it provides a strategic vision for the country that leads to
action. This document outlines key actions to be undertaken by the Federal
Government.


Since taking office, the Obama Administration has worked to engage the
public to evaluate what we are doing right and identify new approaches
that will strengthen our response to the domestic epidemic. The White
House Office of National AIDS Policy (ONAP), a component of the Domestic
Policy Council, has been tasked with leading the effort to develop a
national strategy. Throughout the process, ONAP has taken steps to engage
as many Americans as possible to hear their ideas for making progress in
the fight against HIV. ONAPs outreach included hosting 14 HIV/AIDS
Community Discussions with thousands of Americans across the United
States, reviewing suggestions from the public via the White House web
site, conducting a series of expert meetings on HIV-specific topics, and
working with Federal and community partners who organized their own
meetings to support the development of a national strategy. A report
summarizing public recommendations for the Strategy, entitled Community
Ideas for Improving the Response to the Domestic HIV Epidemic, was
published in April 2010.2


ONAP convened an interagency working group of officials from across the
Federal Government to assist in reviewing the public recommendations,
assessing the scientific evidence relevant to those recommendations,
and making their own recommendations for the Strategy.
This National HIV/AIDS Strategy provides a roadmap for addressing the
domestic HIV epidemic. It is not intended to be a comprehensive list of
all activities needed to respond to HIV/AIDS, but is intended to be a
concise plan that identifies a set of priorities and strategic action
steps tied to measurable outcomes. The Federal Implementation Plan
outlines the specific steps to be taken by various Federal agencies to
support the high-level priorities outlined in the Strategy. Both the
National HIV/AIDS Strategy and the Federal Implementation Plan may be
accessed at www.WhiteHouse.gov/ONAP.


The quantitative targets that we have set are ambitious, and success is
not assured. In the area of HIV prevention, for example, research
conducted at CDC shows that while reallocation of existing resources and
focusing on the most effective interventions will further improve the
impact of HIV prevention efforts, there is still a strong case for making
new investments in prevention, which could pay for themselves by reducing
costly new infections in the future. Achieving these goals, however,
requires stronger partnerships between Federal, State, and local and
tribal governments, as well as faith groups, businesses, foundations, and
community-based organizations. ONAP Oversight, Coordination, and Annual
Reporting ONAP will continue to serve as the lead entity for setting the
Administrations HIV/AIDS policies and will remain engaged in overseeing
government-wide efforts to improve the Nations response to the HIV
epidemic. This role will include working with the Departments to support
and monitor the implementation of the National HIV/AIDS Strategy.
Departments will prepare and submit annual reports to ONAP.


ONAP will use this information to advise the President and produce an
annual report describing the progress toward achieving goals in the
Strategy. In addition, ONAP will continue to convene a Federal Interagency
Working Group to foster collaboration across the Administration. ONAP will
also continue to highlight important issues by convening meetings at the
White House and working with Federal and non-Federal partners.



Role of Federal Departments



To support the implementation of the Strategy, the President has issued a
Presidential Memorandum instructing relevant departments to provide a
report to the President within the next 150 days outlining the steps they
will take to ensure that they implement the recommendations in the
Strategy. Federal agencies will also be tasked with establishing a
responsible entity for coordinating their Departments efforts to achieve
the goals of the Strategy and report on their progress. Other Departments
are instructed to review their policies and identify steps that they can
take to support implementation of the National HIV/AIDS Strategy. A copy
of the Presidential Memorandum can be found at



<http://www.WhiteHouse.gov/Presidential-AIDS-Memo>


<snip>


Summary National HIV/AIDS Strategy Targets for 2015



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).



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.)


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.


*All numbers based on current estimates.



<snip>



Conclusion


HIV is a complex epidemic that requires all of us to address this critical
national public health issue. This Federal Implementation Plan includes
timelines for actions supporting the high-level priorities outlined in the
strategy. This approach reflects a commitment to act with the urgency that
the HIV/AIDS epidemic requires. Federal agencies will strive to take the
steps described in this plan and take other steps to work with other
partners to advance the goals of the National HIV/AIDS Strategy. The
Federal Government, however, is only one of component of the broad effort
needed to improve our response to the domestic epidemic. New partnerships
and a commitment to better coordination and improved accountability will
help us move forward.


With governments at all levels doing their parts, a committed private
sector, and leadership from people living with HIV and affected
communities, the United States can dramatically reduce HIV transmission
and better support people living with HIV and their families.
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.



List of Acronyms


AAPI Asian American and Pacific Islander


ADAP AIDS Drug Assistance Program


AETC AIDS Education and Training Center


AHRQ Agency for Healthcare Research and Quality
http://www.ahrq.gov/


AI/AN American Indian/Alaska Native


AIDS Acquired Immune deficiency Syndrome


ASH Assistant Secretary for Health, Department of Health and Human
Services


BOP Bureau of Prisons, Department of Justice, http://www.bop.gov/


CBO Community-based organization(s)


CDC Centers for Disease Control and Prevention
http://www.cdc.gov/


CMS Centers for Medicare and Medicaid Services
http://www.cms.gov/


DOJ Department of Justice
http://www.justice.gov/


DOL Department of Labor
http://www.dol.gov/


FDA Food and Drug Administration
http://www.fda.gov/


HAART Highly-Active Antiretroviral Therapy


HIV Human Immunodeficiency Virus


HHS Department of Health and Human Services
http://www.hhs.gov/


HOPWA Housing Opportunities for Persons with AIDS
http://www.hud.gov/offices/cpd/aidshousing/programs/


HRSA Health Resources and Services Administration
http://www.hrsa.gov/


HUD Department of Housing and Urban Development
http://portal.hud.gov/portal/page/portal/HUD


IDU Injection Drug Use/User


IHS Indian Health Service
http://wwww.ihs.gov


LGBT Lesbian, Gay, Bisexual, and Transgender


NIH National Institutes of Health
http://www.nih.gov/


OGAC Office of the Global AIDS Coordinator,
Department of State
http://www.state.gov/ogac/


OMB Office of Management and Budget
http://www.whitehouse.gov/omb/


OMH Office of Minority Health
http://minorityhealth.hhs.gov


ONAP Office of National AIDS Policy
http://www.whitehouse.gov/administration/eop/onap/


PACHA Presidential Advisory Council on HIV/AIDS
http://www.whitehouse.gov/administration/eop/onap/pacha


SAMHSA Substance Abuse and Mental Health Services Administration,
http://samhsa.gov/


SSA Social Security Administration
http://www.ssa.gov/


STD Sexually Transmitted Disease


STI Sexually Transmitted Infection


VA Department of Veterans Affairs
http://www.va.gov/




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post.



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