Stepping Up the Pace on HIV/AIDS: Four Years of Progress, More Work to Do

Today, July 15, 2014, marks the fourth anniversary of the release of the National HIV/AIDS Strategy. Thanks to President Obama’s leadership, we have made tremendous progress in addressing HIV/AIDS in the United States over the last four years.

And today we are announcing additional steps to continue to implement the Strategy. They include an $11 million investment funded collaboratively by the HHS Secretary’s Minority AIDS Initiative Fund and the Affordable Care Act, to strengthen the capacity of community health centers to identify and treat HIV. We also are announcing new tools to help states learn from others’ best practices to update their criminal laws to better align with the current science and public health approaches to HIV. These efforts build on the four years of hard work across the government and in partnership with community leaders, states, and others to advance the goals of the Strategy.

The fact sheet we released today details many of these exciting steps, including new access to coverage under the Affordable Care Act, clinical recommendations on HIV screening for everyone between the ages of 15 and 65, realigning of resources to increase investments in cure research, and other important steps.

As we continue to build on this work, over the past few weeks, the White House Office of National AIDS Policy (ONAP) has embarked on a series of listening sessions across the country to hear how the implementation of the National HIV/AIDS Strategy and the Affordable Care Act is impacting people living with HIV, and to learn about the work that HIV health care and service providers are doing.

By visiting diverse communities and listening to the experiences of people living with, or at risk for HIV, and those who deliver prevention and care services, we are better able to understand how our federal policies are affecting people’s everyday lives and helping them move along the HIV Care Continuum, from initial HIV diagnosis to achieving viral suppression.

Recently, we concluded the first in our series of listening sessions and site visits to organizations in several cities in the southern United States, the region of the country that is home to the largest proportion of people living with HIV. Our tour included stops in Jackson, Mississippi; Columbia and Charleston, South Carolina; and Atlanta, Georgia.

We heard from many wonderful, passionate individuals and visited some remarkable programs. The resilience and commitment of the people we met on all four stops truly amazed me, and our federal efforts, including the following, support the important work in these communities: 

• Improving care continuum outcomes among people of color: HHS is supporting a three-year, $44.2 million Care and Prevention in the United States (CAPUS) demonstration project with the goal of developing innovative approaches to reduce HIV and AIDS-related morbidity and mortality among racial and ethnic minorities in eight U.S. cities. This project focuses efforts on improving outcomes along the HIV care continuum, and six of the eight funded states are in the southern United States.
• Housing for people living with HIV: In the Administration’s fiscal year 2015 budget, the Department of Housing and Urban Development’s (HUD) Housing Opportunities for Persons with AIDS (HOPWA) Program proposed readjusting its resource allocation formula to assure that funding is appropriately distributed based on living cases of HIV.

Yet, given local and federal efforts, work remains, particularly in our southern states. Even in this era when more people with HIV are aware of their condition than ever before, and effective HIV treatments are available to slow the progression of the disease, far too many individuals in southern states are still being diagnosed late in the course of their illness, meaning their disease has already advanced to AIDS.

According to CDC data, half of the 17 states in the southern U.S. had higher than national average estimated rates (per 100,000 population) of stage 3 (AIDS) classifications for persons with HIV in 2011. This was made clear on my visit to a medical ward in Atlanta where patients were receiving chemotherapy for Kaposi's sarcoma and other HIV-related cancers, as well as treatment for some AIDS-related opportunistic infections that, though they were commonly seen earlier in the epidemic, have become rarer in the era of effective antiretroviral therapy. 

Still, at each stop, I was pleased to learn the extent to which people at all levels of program and policy are thoughtfully and purposefully focusing their work on the goals and principles of the National HIV/AIDS Strategy. Many spoke enthusiastically about ways their work is aligned with the Strategy’s goals and targets and the concerted activities to address disparities along the continuum of HIV care, as the President called on all of us to do last summer with his Executive Order on the HIV Care Continuum Initiative.

Our listening tour has also included stops in San Francisco and Oakland, and continues on to Chicago and New York City (register for these sessions here). We look forward to sharing with you what we learn about how these communities are implementing the National HIV/AIDS Strategy and how the Affordable Care Act expands opportunities to access affordable coverage, as well as potentially replicable and scalable models developed in those communities that can inform our work to reach the goals of the Strategy, improve outcomes all along the HIV care continuum, and realize President Obama’s vision for an AIDS-free generation.

Douglas Brooks is the Director of the Office of National AIDS Policy.