Office of National AIDS Policy Blog
- Posted byon May 26, 2011 at 4:08 PM EST
Last week, I wrote about my attendance at the PEPFAR annual meeting in South Africa, the country that has more people living with HIV (over 5 million) than any other country in the world. After this meeting, I visited the neighboring country of Swaziland, which has the unwelcome distinction of having the highest HIV and TB prevalence rates in the world.
This part of my trip had special personal significance for me. Twenty-one years ago, I had the privilege of serving as a United States Peace Corps volunteer in Swaziland, where I worked as a high school science teacher. This trip really was part homecoming as Swaziland remains a part of me, and it gave me a chance to reconnect with many friends whom I haven’t seen in more than a decade. But, I also spent several days with the PEPFAR team in the country – especially the Peace Corps - learning about the broad range of ways that the United States government is extending a hand of friendship and is partnering with Swaziland to respond to their HIV epidemic.
- Posted byon May 19, 2011 at 8:00 AM EST
“Saving face can't make you safe. Talk about HIV – for me, for you, for everyone.”
That’s the motto for National Asian and Pacific Islander HIV/AIDS Awareness Day on May 19.
According to the Banyan Tree Project, which sponsors this Awareness Day on behalf of a wide cross-section of organizations serving Asians and Pacific Islanders:
"Saving face" is a common cultural concept in A&PI communities, where individuals seek to protect the family from perceived public shame or disgrace. In practice, "saving face" contributes to silence about sex, HIV, and safe sex practices. Saving face and stigma also lead to higher rates of HIV infection and a lack of knowledge about one's HIV status.
As an Asian-American physician who has cared for patients with HIV/AIDS, I’ve seen the stigma of HIV firsthand. It’s time to put an end to it.
Last May, I had the honor of blogging about the importance of observing National Asian and Pacific Islander HIV/AIDS Awareness Day. I want to reiterate some important points I made then— and also highlight that since then, the White House has released the National HIV/AIDS Strategy (NHAS), a roadmap for reducing the number of new HIV infections, increasing access to care and improving health outcomes for people living with HIV, and reducing HIV-related health disparities.
Current data suggest that Asian Americans and Pacific Islanders (AAPIs) represent approximately one percent of diagnoses of HIV infection nationally—but the rate of HIV diagnoses among certain AAPI populations is higher than some other groups. In 2009 (the latest year for which we have data), the estimated rate of diagnoses of HIV infection among Native Hawaiian and other Pacific Islander men per 100,000 population (41.2) was nearly three times that of White men (14.8).
There were relatively few diagnoses of HIV infection among Asian and Native Hawaiian/other Pacific Islander women in 2009; however, the rates for these groups (3.4 and 13.3, respectively) were higher than the rate for White (2.4) women. The number of AAPIs diagnosed with HIV or AIDS may be larger, since we have reason to believe HIV is underreported among this group.
As part of our commitment to the NHAS, the U.S. Department of Health and Human Services is working to improve our data collection. We want to understand the full impact of HIV/AIDS on all populations, including AAPIs, because better information helps us provide better prevention, testing, and treatment options. Those options will move this country closer to ending the HIV/AIDS epidemic—for the AAPI community and everyone else too.
On June 5, we will mark 30 years since the first published reports of AIDS. One of the best ways we can commemorate that date is to talk about HIV within our families, among our friends, and in our communities. We can reaffirm our commitment to ending the suffering through HIV awareness, testing, treatment, and care.
I encourage you to visit the Banyan Tree Project’s website to find information about events, posters, and other resources in your community for National Asian and Pacific Islander HIV/AIDS Awareness Day. “Saving face” can’t make us safe—but awareness and action can. Please join us!
To find an HIV testing site or other HIV services near you, visit http://locator.AIDS.gov to access the HIV Prevention and Services Provider Locator. By entering your address or ZIP code, you can find HIV testing, mental health, substance abuse, housing, health care, and family planning resources near you.
Howard K. Koh M.D., M.P.H., is Assistant Secretary for Health, U.S. Department of Health and Human Services
- Posted byon May 17, 2011 at 8:00 AM EST
HIV Vaccine Awareness Day provides an opportunity to acknowledge the more than 35,000 individuals who have volunteered for preventive HIV vaccine trials over the past 25 years. Without their participation, the modest success that we have achieved thus far would not have been possible. Many thousands more volunteers will be needed if we are going to achieve our ultimate goal of developing a safe and effective vaccine that will help stop the spread of HIV worldwide.
Since the discovery of HIV in 1983, dozens of antiretroviral agents have been licensed and have resulted in dramatic improvements in the quality of life and life expectancy of millions of HIV-infected individuals. In addition, global access to these life-saving therapies has been progressively increasing, which not only benefits the HIV-infected individual, but makes them less likely to transmit the virus to their sexual partners. However, for every individual who gains access to these therapies globally, two to three individuals become newly infected. Treatment alone is not likely to rid the world of AIDS; the need for improved approaches to prevent new HIV infections is compelling.
Fortunately, through the combined support of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH), other US Government agencies, nonprofit organizations, and others, progress in developing new technologies that prevent HIV infection has been notable. Adult male circumcision resulted in greater than 50% protection against HIV acquisition among heterosexual men in several African countries. A once a day pill was shown to reduce new infections in men who have sex with men by 44%, and protection appeared even higher in those men who adhered to the daily drug regimen. Promising results have also been achieved with a vaginally applied microbicide, which protected 39% of women in a trial in South Africa. Again, protection was higher in those who adhered to the drug use schedule. Another exciting finding is that a vaccine provided 31% protection in a heterosexual population in Thailand. Interestingly, efficacy appeared to be 60% in the earlier stages of the trial before the vaccine induced immune responses waned.
Our goal now is to improve upon these latter results. Why did this vaccine work and can we build on that knowledge to design more effective vaccines? Will a vaccine adjuvant or vaccine vector increase the level of protection? Can efficacy be achieved in higher incidence populations and in populations exposed to different subtypes of HIV? Will keeping vaccine induced immunity high for a longer period of time increase the duration of protection? Are there alternative approaches to ensuring that effective immunity is present when individuals are exposed to HIV? These are all questions that NIAID together with our partners plans to address through continued basic and clinical research.
Conducting additional clinical vaccine research presents technical, resource and logistical challenges that will require multi-sector, international partnerships to address. Engagement of the private sector and regulatory agencies will help map a path to vaccine licensure. Clinical trial specialists will apply their best strategic thinking to determine how multiple trials can be efficiently and effectively accomplished. Participation of government officials and researchers in the countries where trials will be conducted will ensure that trials are approved and carried out expeditiously and according to the highest ethical standards. Strong partnership with affected communities and trial volunteers will help make certain that they understand the risks and benefits of participation in HIV vaccine trials. Only through continued support and participation of communities and individual trial volunteers will we achieve the goal of identifying a safe and effective preventive vaccine, which would be an invaluable addition to the tool box of prevention approaches.
Anthony S. Fauci, M.D. is the Director, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health
Margaret I. (Peggy) Johnston, Ph.D., is a Senior Scientific Consultant, NIAID
- Posted byon May 9, 2011 at 2:23 PM EST
Last week, I was in Johannesburg, South Africa, where I attended the annual meeting of the President’s Emergency Plan for AIDS Relief. Known as PEPFAR, this is the United States global HIV/AIDS program that was established by President Bush. PEPFAR has been continued and strongly supported by President Obama. The focus of this Administration has been to move the program from an emergency response to a sustainable, long-term effort that builds the capacity of host countries to take the lead in responding their HIV epidemics. Indeed, in 2009, President Obama announced his Global Health Initiative (GHI) that acknowledges the enormous success of PEPFAR and seeks to build on this effort by strengthening health systems to tackle other health problems.
It is humbling and exciting to be with this group of committed Americans and host country partners. The American people should be proud of the fact that we are leading the response to the global pandemic and our work is literally saving the lives of millions of people around the world. A couple of statistics caught my ear. Through PEPFAR, 385,000 infants have been born HIV-free who otherwise would have been born with the virus. More than 100,000 of these births have been in the last year alone. The PEPFAR program is currently supporting more than 3.2 million people on anti-retroviral therapy, an amazing achievement for a program that is only 7 years old. What an enormous achievement! I could cite facts and figures for days, but the most meaningful way to see the impact of our efforts is to visit the clinics and programs that the US government is supporting. With CDC Director Dr. Tom Frieden, I visited a local clinic and a hospital in Tembisa, a community outside of Johannesburg that is home to two million people. I also visited Helen Joseph Hospital in Johannesburg, a research hospital and one of the largest HIV treating hospitals in South Africa, as well as Nazareth House, a Catholic institution that cares for children orphaned by HIV. It is hard to describe the feeling of seeing hundreds and hundreds of people living with HIV, many of whom are on HIV treatment, and to hear them thank PEPFAR and the American people for helping to keep them alive.
I came here hoping to learn lessons from Africa and other parts of the world to apply to the domestic epidemic. There are lots of lessons as we work to implement the National HIV/AIDS Strategy. What I found is that PEPFAR is grappling with so many of the same issues. There has been a lot of talk about combination prevention. As with domestic HIV programs, there is concern here about the challenging fiscal environment—and this is leading everyone to ask if they are prioritizing the right programs and interventions to save as many lives as possible. Interestingly, there has been a lot of discussion about coordination among PEPFAR’s implementing agencies—State, CDC, USAID, Peace Corps, Department of Defense—and working with the host countries and their health systems. This mirrors the challenges and opportunities of coordinating CDC, CMS, HRSA, and HUD, as well as the challenges and opportunities working with state and local governments. I am not walking away with any magic solutions, but this meeting has given me a lot to think about… We definitely need to do more to integrate our domestic and global efforts.
As I left this meeting, I was energized by the committed people I met who are working so hard to achieve the vision similar to the U.S. National HIV/AIDS Strategy, but on a global scale.
Jeffrey S. Crowley is the Director of the Office of National AIDS Policy
Institute of Medicine Releases Report on Health Care System Capacity for Increased HIV Testing and Provision of CarePosted byon March 18, 2011 at 6:06 PM EST
Today, the Institute of Medicine (IOM) released its third and final report in a project commissioned by the Office of National AIDS Policy (ONAP). Entitled “HIV Screening and Access to Care: Health Care System Capacity for Increased HIV Testing and Provision of Care,” the report examines the current capacity of the health care system to administer a great number of HIV tests and accommodate new HIV diagnoses.
More than 200,000 people in the United States are living with HIV, but unaware of their status. Increased HIV testing may help identify these individuals, reducing the chance that they will transmit HIV to others and improving their own health outcomes. But some individuals may not receive the care they need if the health care system does not have the capacity to care for them.
The report finds that budget constraints at state and local health departments pose a barrier to more widespread HIV testing. In addition, fewer practitioners are specializing in HIV/AIDS care and the number of specialists entering the workforce is not replacing the number retiring. Among the report’s findings, the report concludes that, to meet the growing demand for care, more practitioners need training in HIV/AIDS treatment and care; and hospitals, clinics, and health departments must receive sufficient funding to maintain their staff and support screening efforts.
The Affordable Care Act (ACA), the landmark health reform legislation signed into law by President Obama in March 2010, includes several provisions to expand and better support the health care workforce. These provisions also create opportunities for addressing some of the HIV workforce challenges indentified in this report. The National HIV/AIDS Strategy for the United States recognizes the importance of ensuring that all people living with HIV know their HIV status and are well supported in a regular system of care. The Strategy states that public and private sector entities must take the steps to improve service delivery for people living with HIV by: establishing a seamless system to immediately link people to continuous and coordinated quality care when they are diagnosed with HIV; taking deliberate steps to increase the number and diversity of available providers of clinical care and related services for people living with HIV; and, supporting people living with HIV with co-occurring health conditions and those who have challenges meeting their basic needs, such as housing.
In 2009, ONAP commissioned the IOM to convene a 15-member Committee on HIV Screening and Access to Care, which was tasked with planning and conducting a series of three workshops and activities that evaluate barriers to expanded HIV testing and treatment programs. The outcome of these efforts is the issuance of three reports that examine certain questions related to HIV testing policy and access to care. The Committee’s first report focused on the extent to which Federal and State laws and policies, private health insurance policies and practices, and other factors inhibit or promote expanded HIV testing. The second report studied how Federal and State laws and policies and private health insurance policies affect entry into clinical care and the provision of continuous and sustained care for people with HIV.
ONAP thanks the Committee for its efforts. These reports will inform our collective efforts to implement the Strategy.
To view this report and the entire report series, please visit the IOM website, www.iom.edu.
Jeffrey S. Crowley is the Director of the Office of National AIDS Policy
- Posted byon March 18, 2011 at 1:31 PM EST
HIV remains a highly stigmatized condition. It is a serious medical condition and people still die of AIDS. Nonetheless, we have highly effective treatments for people living with HIV and better tools than ever before to prevent infection. As uncomfortable as it may be for some people to talk about HIV and AIDS, discussing the basic facts about transmission, testing, and treatment are essential to stopping this epidemic in its tracks. That is why on Sunday, March 20th, we will commemorate the fifth annual National Native HIV/AIDS Awareness Day to educate and encourage American Indians and Alaska Natives (AI/AN) to take action to stop the spread of this disease.
The Centers for Disease Control and Prevention (CDC) estimates that American Indians and Alaska Natives represent less than 1 percent of those living with HIV. However, these communities continue to be impacted by HIV. CDC surveillance data show that from 2006 through 2009, the estimated annual rate of HIV diagnosis increased among AI/AN people. In 2009, the estimated rate of HIV diagnosis was 9.8 per 100,000, higher than the rate for white and Asian Americans. Additionally, the CDC estimates that approximately 26% of AI/AN people living with HIV are unaware of their infection. Once diagnosed with AIDS, AI/AN people are less likely to survive compared to HIV-positive individuals in other communities.
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