Continuing Steps to Implement the National HIV/AIDS Strategy as the Pandemic Turns 30

As we reflect on the thirtieth year of the HIV pandemic, our work continues.  I wanted to share with you two developments at the White House as we mark this somber, but important milestone.

HHS Announces New Steps to Implement the National HIV/AIDS Strategy

Yesterday, I participated in a call with Health and Human Services Secretary Kathleen Sebelius and key leaders in her Department who announced new actions to support the implementation of the National HIV/AIDS Strategy.

Mary Wakefield, PhD, RN, Administrator of the Health Resources and Services Administration (HRSA)discussed the Administration’s continued commitment to supporting States in responding to the challenge of state waiting lists in the AIDS Drug Assistance Program (ADAP).  Funding for ADAP has enjoyed broad bipartisan support.  Even in a tough budget climate and at a time when other critical health programs received cuts, the Administration fought for and achieved a $50 million increase in funding for ADAP in FY 2011 compared to the enacted level for FY 2010.  This year, the Federal government alone will invest $885 million in the ADAP program.  Administrator Wakefield announced that the increased funding will allow a temporary program established last summer with $25 million in emergency funds to continue and HRSA will allocate the remaining increase through both the ADAP formula program and through a targeted, competitive grant process to assist States with waiting lists or other cost containment measures that could impede access to critical medications.  While there are challenges in ensuring that individuals have access to life saving medications, HRSA is working closely with states and encouraging pharmaceutical companies to help bridge the gap in this program until state economic conditions improve and the Affordable Care Act alleviates some of the pressure on this program. 

Ms. Cindy Mann, Deputy Administrator of the Centers for Medicare and Medicaid Services (CMS) and Director of the Center for Medicaid, CHIP, and Survey and Certificationdiscussed a State Medicaid Director (SMD) letter, issued yesterday, that informs States of various opportunities in Medicaid to improve care coordination and care delivery for people living with HIV, as well as opportunities to use Section 1115 HIV demonstration waivers to expand access to Medicaid for people living with HIV.  To facilitate States considering a Section 1115 demonstration waiver, CMS also issued a template and stated that they will work with States to develop streamlined and flexible approaches to meeting legal and policy requirements for these waivers.  The commitment to issue this waiver guidance was made in the Federal Implementation Plan for the National HIV/AIDS Strategy and in some states, could provide a mechanism for relieving pressure on ADAP while also providing more coordinated and high-quality care. 

A blog post by CMS Administrator Don Berwick can be found HERE. The SMD issued by CMS can be found HERE.

Dr. Tom Frieden, Director of the Centers for Disease Control and Prevention (CDC)described CDC’s vision for high-impact HIV prevention.  He announced that even in a very difficult budget environment, CDC was increasing its investment in HIV prevention services by $31 million in FY 2011.  He also described some of the targeted new prevention investments CDC is making as it realigns its entire HIV prevention portfolio to have a bigger impact.  He spoke of the need, articulated in the National HIV/AIDS Strategy, to focus on the geographic, demographic, and programmatic characteristics of the HIV epidemic.  In particular, he highlighted the need to better address gay and bisexual men of all races and ethnicities (but especially gay and bisexual men of color), because they reflect the majority of new infections and the only group in the US where infection rates are rising.  He discussed the Enhanced Comprehensive HIV Prevention Planning (ECHPP) initiative in the twelve cities and surrounding metropolitan areas that account for nearly half (44%) of the HIV cases in the United States.  He described this as a platform for making improvements in planning that will be applied across CDC’s HIV prevention programs.  He discussed CDC’s investments in helping state and local jurisdictions track and report CD4 and viral load measurements in order to track community viral load.  Research studies have demonstrated that when a community is able to lower the mean viral load across all people living with HIV in that community that this leads to a lowering in HIV incidence.  Therefore, tracking community viral load is an important tool for reducing the number of new infections.  CDC is doing important work to support states and localities in building their capacity to track community viral load. 

Each of these agencies announced significant new initiatives yesterday that move us forward in implementing the National HIV/AIDS Strategy.  Their impact, however, is greatest when viewed together.   We have a stronger evidence base than ever before and a clearer vision of how to support individuals and communities in lowering their risk of becoming infected with HIV, helping individuals living with HIV to learn their status, and how to bolster the programs that support individuals with HIV in accessing the care and services they need (including access to antiretroviral therapy).  Our work continues, but we are making definite forward progress.

Champions of Change

Champions of Change is a weekly White House  initiative to highlight Americans who are making an impact in their communities and helping our country rise to meet the many challenges of the 21st century.  Last week, we invited a diverse group of people living with HIV to join me; Health and Human Services Assistant Secretary for Health, Dr. Howard Koh; Brian Bond, Deputy Director of Public Engagement and former ONAP staffer and Senior Scientist at CDC, Greg Millett - both people living with HIV; as well as Allison Nichol and David Knight of the Civil Rights Division at the Department of Justice and David Vos, Director of the Office of HIV/AIDS Housing at the Department of Housing and Urban Development for a round table to discuss their experiences as people living with HIV. 

For more than two years we’ve been working in close partnership with many members of the HIV community and as we enter our fourth decade fighting HIV/AIDS, we believed it was important to again hear from the collective wisdom of people living with HIV in order to assess our progress and make plans for concerted efforts going forward.  Everyone has something to contribute toward ending this pandemic. That’s why we have been working with people living with HIV every step of the way.  We felt it was important to meet with HIV positive leaders and hear about the lived experiences of people who may be still facing stigma in their own communities.  Many who may still struggle to gain access to services, yet who are working everyday to support their communities as they respond to HIV.  The discussion was very powerful and it generated a lot of good ideas.  

Check out this introductory post from Brian Bond HERE and learn about these incredible individuals HERE.  And check back, as this page will be updated throughout the week with posts by each of these individuals.

Jeffrey S. Crowley is the Director of the Office of National AIDS Policy