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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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