White House Briefing: A New National AIDS Strategy

During his campaign for president, Barack Obama promised to develop a National AIDS Strategy that would vastly improve our current approach and, in the process, improve the lives of those infected with the virus. On June 17th, 2010, the Office of National AIDS Policy, the White House, and aids.gov hosted a briefing on the domestic HIV/AIDS epidemic and the status of a new HIV strategy in the US. On behalf of About.com AIDS, I attended that briefing and came away optimistic, encouraged, and cautious.

The State of HIV/AIDS in the United States

As part of the briefing, Gregorio Millett, MPH, of the Centers for Disease Control and Senior Policy Advisor in the Office of National AIDS Policy, provided an update on the state of HIV/AIDS in the United States.

• 1.1 million people in the United States are living with HIV, 20% of whom have no idea they are infected. This is significant because people who are unaware of their HIV infection are more likely to transmit their virus.

• Despite current HIV prevention efforts, there are about 56,000 new HIV infections each year in the United States. What's more telling is that while HIV can infect anyone, all people are not equally affected.

• Men who have sex with men account for only 2% of the U.S. population, but more than half of new HIV infections.
• Men who have sex with men are infected at a rate 44 times greater than men who don't have sex with men and 40 times greater than women.
• African Americans make up 20% of the population but 50% of the new infections.
• Latinos make up 15% of the population but 17% of new infections; they are infected twice as often as white men and 4 times as often as white women.
Despite advances in HIV care, AIDS is the third leading cause of death among African Americans 25 to 44 years old, and the fourth leading cause of death among Latinos of the same age.

The New National AIDS Strategy - An Update

One of President Obama's top HIV priorities is the development and implementation of a National HIV/AIDS Strategy (NHAS). The President has identified 3 goals for the NHAS:

• Reduce the incidence of HIV
• Increase access to care and improve outcomes.
• Reduce HIV-related health disparities.

To explain how these goals will be met by the new strategy, Jeffrey Crowley, MPH, Director of the Office of National AIDS Policy and the President's lead HIV/AIDS advisor, explained the process used when developing the NHAS.

The Process for a National AIDS Strategy

The Office of National AIDS Policy has worked with people from all over the United States and its territories to assess the needs of people living with HIV. Those most affected by HIV, or "shareholders" as they are referred to by Crowley, have been an important part of the strategy development from the very beginning. First, community meetings were held all over the country; in addition, over 1,000 people contributed their opinions via the Internet; finally all branches of government -- including state, local, and federal -- were polled to identify the most urgent needs, which are:

• Reduce the Incidence of HIV - One goal of the NHAS is to make new HIV infections a rarity. Specifically, Obama's plan wants to reduce the incidence of HIV by 25 percent over the next 5 years. To do this, targets of prevention efforts must be expanded to include the hardest-hit populations. If necessary, multiple prevention methods can be employed in the same targeted areas.

  Crowley stressed that coordination of efforts across populations, communities, and governments is an essential part of the new strategy. Furthermore, HIV care must be readily available for everyone regardless of sex, ethnicity, race, or financial status. To do this, the new strategy must provide a seamless system of care access from testing to diagnosis and beyond.

  In addition, efforts must be refocused especially in areas with high concentrations of infection (e.g. Latinos, MSMs, and certain geographical areas).



• Increase Access to Care and Improve Outcomes - The first step to meet this goal will be to assemble an expanded and diverse HIV workforce. With this workforce, the new strategy will provide support for not only HIV care, but concurrent illnesses as well. It's a fact that people in care transmit HIV far less than those who are not receiving care. So meeting this goal, according to Crowley, will in turn help achieve the first goal.


• Reduce Disparities in Care - The first step is to decrease and eventually eliminate HIV related stigma that interferes with health care. That, along with better community-level intervention and coordination of care across all aspects of HIV services, will eventually decrease health care disparity. And to ensure this is the case, better monitoring tools and communication are a must.

In just over 30 minutes, the White House briefing provided a wealth of information about the government's new direction for HIV services. However, I did not leave without questions. My biggest concern: What makes this new strategy different from promises we have heard in the past -- promises of better care, access, and services for HIV?

When asked what makes this strategy different, Mr. Crowley pointed out the 18 months of hard work that went into the new strategy and described it as a coordinated effort in all facets of development and implementation. This, Crowley said, will be the difference between empty promises and the new NHAS.

Time will tell, but if the new strategy is all that has been promised, the United States will be the leader in HIV prevention, education, and care -- an example for countries around the world. Let's keep our fingers crossed.

_Source:

_{Gomez, M.; "Briefing on the Domestic HIV/AIDS Epidemic in Advance of National HIV Testing Day"; Office of National AIDS Policy; 17 June 2010.}