Implementing the National HIV/AIDS Strategy Across the United States

Successful implementation of the National HIV/AIDS Strategy (the Strategy) requires ongoing collaboration among Federal, state, and local governments and key non-governmental stakeholders.  As part of our ongoing efforts to support Strategy implementation, ONAP is convening community discussions across the United States. Discussions are focusing on the following key areas:

• State and local efforts to concentrate resources in communities where HIV is most common and to scale-up evidence-based interventions
• Interventions to improve outcomes along the “care cascade” (i.e. moving people from an HIV diagnosis to care, treatment, and viral suppression)
• The importance   of the Affordable Care Act implementation for HIV care and prevention

To date we have visited three cities: Miami, Florida (December 18, 2012); Los Angeles, California (February 14, 2013); and Chapel Hill, North Carolina (February 21, 2013). At each meeting, state and local public health officials, representatives from community-based organizations, advocates, and other key stakeholders convene. ONAP and other Federal partners provide information about the current state of the epidemic nationally and ongoing Federal efforts to implement the Strategy. Key stakeholders provide their perspectives on implementation efforts at the State, local, and community levels. ONAP staff also visit local clinics, community-based organizations, and academic centers to hear what these organizations are doing prevent and treat HIV. The goal is to share information, identify strategic priorities, and determine next steps for moving forward.

The partnership between the Federal government and our colleagues across the nation is bringing positive results. A common theme at each of these meetings has been a strong commitment to aligning local and State efforts with the Strategy and an excitement that, with recent breakthroughs in understanding and treating HIV, we are at a “tipping point,” where our collective efforts will turn the epidemic around.  What also stands out is the dedication of public health officials, researchers, clinicians, community service providers, and volunteers working diligently to implement the Strategy. It is inspiring to see the depth of commitment to the goals of the Strategy and the ways in which people are bringing their passion and creativity—backed by evidence and data—to bear on their local epidemics.

A focus of these meetings has been on improving outcomes along the HIV care cascade . This is a priority because nearly one-fifth of persons living with HIV in the United States are unaware of their infection, while only one-quarter have a suppressed viral load. State and local jurisdictions are asking themselves:  “What do we need to do, as a system, to reach out in culturally competent and accessible ways to bring people into care and treatment?” This theme came up repeatedly during our meetings and local efforts are increasingly focused on addressing this question.

It is also clear that the Affordable Care Act is and will continue to helping State and local efforts to improve outcomes along the HIV care cascade. Currently, as a result of the healthcare law, there are 71 million Americans receiving expanded preventive services coverage without cost-sharing. In 2014, about thirty million Americans will become eligible for affordable coverage options, including tens of thousands of people living with HIV. And, insurance companies will not be able to deny coverage for pre-existing conditions, including an HIV diagnosis.

Discussions have also identified areas with ongoing challenges, including: the need to reach out more effectively to vulnerable populations, including gay and transgender youth, young women of color, and homeless persons; the imperative of addressing HIV-related stigma and discrimination as key parts of our work; and the ongoing challenges of collecting accurate, timely data and using it efficiently to inform decision making. ONAP and our Federal agency colleagues remain committed to helping address these and other challenges as part of Strategy implementation.                                                                

In the two and a half years since the Strategy was released, we have made remarkable progress at the Federal, State, and local levels. We look forward to the ongoing conversation and continuing our work implementing the Strategy.  

Grant Colfax, MD is Director of the Office of National AIDS Policy