Office of National AIDS Policy Blog
- 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.
- Posted byon March 10, 2011 at 1:37 PM EST
Today is the sixth annual National Women and Girls HIV/AIDS Awareness Day, a nationwide initiative coordinated by the U.S. Department of Health and Human Services’ Office on Women’s Health (OWH) to make more people aware of the increasing impact that this deadly epidemic is having on women and girls in the United States. This is the time when we ask individuals and organizations across the country to bring attention to this epidemic and to take action to prevent the spread of this disease.
Since the beginning of the epidemic, women have been impacted by HIV and AIDS. Over the last two decades, the proportion of estimated AIDS cases diagnosed among women has more than tripled, from 7 percent in 1985 to 25 percent in 2009. Women of color are especially impacted—HIV diagnosis rates for Black women is nearly 20 times the rate for white women. HIV infection is one of the leading causes of death among Black and Latina women age 25-44 years.
- Posted byon February 24, 2011 at 5:02 PM EST
When President Obama released the National HIV/AIDS Strategy in July 2010, he said, “The Federal government can’t do this alone, nor should it. Success will require the commitment of governments at all levels, businesses, faith communities, philanthropy, the scientific and medical communities, educational institutions, people living with HIV, and others.”
Clearly, success at achieving our aggressive goals in the Strategy depends not only on Federal leadership, but new investments and new partnerships from all parts society. We know that some of our biggest successes in fighting HIV/AIDS have come about because of private sector initiatives, and we’ve called on businesses and foundations to provide that next level of leadership by stepping up their efforts in a few targeted areas. We want to hear about your successful partnerships and new ideas for working together.
Priority areas where private sector partners can help us to achieve the National HIV/AIDS Strategy goals are:
- Bridging the gap in access to HIV medications: Over the past year, a growing challenge has arisen as an increasing number of people living with HIV are placed on waiting lists for state operated AIDS Drug Assistance Programs (ADAP). Most states have managed to avoid imposing these waiting lists, but nearly 6,500 people in 11 states are currently on waiting lists. Even states without these lists have had to make difficult decisions such as to restrict the scope of drug coverage available or to limit the income standards of people who qualify for assistance. The Federal government has a role to play in responding to this situation and states must remain committed to investing in these programs, but we need the continued commitment from our private sector partners to weather the economic downturn that is afflicting many parts of the country. Pharmaceutical companies and related charitable organizations have maintained patient assistance programs that provide critical aid to those in need. We are appreciative that these companies have maintained and increased their commitments in this area. Foundations have also helped to support community efforts to bolster state investments in programs providing HIV medications.
- Ensuring that the HIV community and people living with HIV take full advantage of the benefits of the Affordable Care Act: The Affordable Care Act will greatly expand access to insurance coverage in 2014, and there are already numerous immediate benefits for people living with HIV and others. Private sector partners can help the HIV community work through the implementation phase by helping people living with HIV and the HIV care system learn about the improvements in insurance coverage and critical steps to be taken both to ensure that no new gaps in coverage appear as people gain new coverage. Private sector partners also can ensure that HIV clinics, clinicians, and services providers are adapting to and engaging in the newly expanded insurance system.
- Improving understanding, reducing stigma, and communicating actionable information to the public, especially among most affected communities: The Centers for Disease Control and Prevention (CDC) and other Federal agencies have a role to play in operating social marketing initiatives and other programs to improve understanding about HIV. At the same time, the private sector has unique experience, expertise, and assets to bring to bear. As we focus on the populations and communities at greatest risk, private sector partners can help to deliver action-oriented information on issues such as prevention, testing, and treatment, including promoting early entry into clinical care for people living with HIV and increasing knowledge about HIV and reducing stigma surrounding HIV/AIDS. The private sector can also fill an important need by strengthening critical community institutions and supporting capacity building of community based organizations within the communities most disproportionately impacted by HIV, such as within local organizations serving Black and Latino gay men, youth (including homeless youth and LGBT youth), substance users, and women of color.
- Supporting innovative partnerships in the cities and communities with the most cases of HIV: CDC has begun important work in the twelve jurisdictions in the United States with the greatest number of people living with AIDS. HHS and HUD are also considering a variety of complimentary new initiatives to build on CDC’s work in order to better integrate all of the HIV resources within a community. This project has relevance not only for these communities, which are responsible for roughly 44% of the epidemic in the US, but it will teach us valuable lessons to be applied to our collective work with other states and jurisdictions across the country. Private sector partners can support this effort many ways, such as helping community-based partners engage with local government partners on this initiative, coordinating current and new prevention and care efforts in these communities, partnering on outreach efforts, and conducting evaluations and efforts to transfer lessons so that other areas of the country can benefit from the experiences in these high prevalence jurisdictions. This will also compliment other work of the private sector in responding to high levels of unmet need in other communities, such as in the South.
The National HIV/AIDS Strategy provides a moment of opportunity to make big things happen. Business and labor partners, foundations, and other charitable organizations have long made critically important contributions to support individuals and communities affected by HIV/AIDS, often by working with governments to test new ideas or expand successful programs. Over the coming months, the Administration will be looking for opportunities to partner with the private sector to achieve the goals of the National HIV/AIDS Strategy.
So, we want to hear from you – the innovative leaders in this space who are undertaking new initiatives to support the implementation of the National HIV/AIDS Strategy. Tell us about your successful partnerships and new ideas for working together at AIDSpolicy@who.eop.gov.
Melody C. Barnes is an Assistant to the President and Director of the Domestic Policy Council
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