Office of National AIDS Policy Blog

  • 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

     

  • What You Missed: Open for Questions 30 Years of AIDS

    Yesterday, Surgeon General Dr. Regina Benjamin, Director of the White House Office of National AIDS Policy Jeffrey Crowley and Director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, NIH, Dr. Carl Dieffenbach came to the White House for a special live chat on 30th anniversary of the AIDS epidemic.  Check out the video of the chat below.

    For events, timelines and more information about the 30th anniversary of AIDS visit AIDS.gov.  And to find out more information about HIV testing and treatment, as well a mental health, substance abuse, family planning and housing services, check out the HIV/AIDS Prevention and Services locator

    Download Video: mp4 (325MB) | mp3 (31MB)

  • Open for Questions: 30 Years of AIDS

    On Wednesday June 1, 2011 at 3 p.m. EDT, Surgeon General Dr. Regina Benjamin, Director of the White House Office of National AIDS Policy Jeffrey Crowley and Director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, NIH, Dr. Carl Dieffenbach will be hosting a special live discussion on the 30th anniversary of the AIDS epidemic.  Submit your questions in advance and tune in to WhiteHouse.gov/live to watch the discussion. 

    • What: Open for Question: 30 Years of AIDS
    • When: June 1 at 3 p.m. EDT
    • Who: Surgeon General Dr. Regina Benjamin, Director of the White House Office of National AIDS Policy Jeffrey Crowley and Director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, NIH Dr. Carl Dieffenbach
    • Where: Submit questions in advance, watch live at WhiteHouse.gov/live and submit live questions during the discussion on Facebook.

  • My Visit to Swaziland: The Country with the World’s Highest HIV Prevalence Rate

    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.

  • National Asian and Pacific Islander HIV/AIDS Awareness Day

    “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

  • HIV Vaccine Awareness Day, 2011

    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