Office of National AIDS Policy Blog

  • Expanding Access to Evidence-Based Services for Injection Drug Users

    Cross posted from the ONDCP blog Of Substance.

    We have known from the very beginning of the HIV epidemic that sharing needles and other drug-related paraphernalia is associated with transmission of HIV and other infectious diseases including hepatitis B and C.  The Centers for Disease Control and Prevention (CDC) recently reported that injection drug use accounts for 12% of new HIV infections each year in the United States. Globally, it is estimated that 5-10% of new infections result from injection drug use.
    On December 16, 2009, President Obama signed into law an end to the longstanding ban on most Federal funding for needle exchange programs.  The  removal of this ban will aid local communities in their efforts to fund needle exchange programs. As a result, the Departments of State and Health and Human Services (HHS) have recently issued policy guidance for U.S.  programs and global partners in the President’s Emergency Plan for AIDS Relief (PEPFAR) program interested in implementing syringe services programs (SSPs).
    The Office of National Drug Control Policy has recently released its National Drug Control Strategy and the Office of National AIDS Policy released  its National HIV/AIDS Strategy this past Tuesday. Both strategies are aligned on the important role of syringe services programs (SSPs)  as part of more comprehensive approaches to preventing transmission of infectious disease and linking people to needed services.  The policy guidance issued by HHS and State requires that SSPs be implemented as part of a comprehensive program for injection drug users that includes linkage and referral to substance abuse prevention and treatment services, mental health services, and other support services.  HHS Guidelines stipulate that programs must comply with local laws and regulations and cannot operate in locations where the programs are opposed by public health and law enforcement officials.
    Over the years, many trusted experts and scientific institutions have endorsed the effectiveness of SSPs  in contributing to the reduction of  HIV transmission, including the CDC, the National Institutes of Health, and the American Medical Association.  SSPs are also cost-effective:  It is estimated that lifetime costs for treating HIV infection is in excess of $350,000 compared to less than $2 cost of providing a sterile needle.
    Despite their success, only about 7% of injection drug users in the U.S. have access to SSPs and HIV epidemics in some PEPFAR partner countries are largely driven by injection drug use.  These guidelines are an important step forward in preventing HIV infection and expanding access to needed HIV services for injection drug users.  ONDCP and ONAP look forward to continuing to collaborate on ensuring the widespread dissemination and application of these guidelines and to improving public health.
    R. Gil Kerlikowske is the Director of the Office of National Drug Control Policy (ONDCP) and Jeffrey S. Crowley is the Director of the Office of National AIDS Policy (ONAP).

  • National HIV/AIDS Strategy: Reducing New Infections, Improving Care, Ending Health Disparities

    Read the Transcript  |  Download Video: mp4 (124MB) | mp3 (12MB)

    Yesterday, the White House Office of National AIDS Policy (ONAP) released the National HIV/AIDS Strategy – a comprehensive plan for fighting HIV in our country.

    In his remarks at a reception with HIV/AIDS policy experts and activists, the President acknowledged that as a Nation, we have come a long way in the battle against the domestic HIV/AIDS epidemic, but that we still have much work left to do: 

  • Announcing the National HIV/AIDS Strategy

    Download Video: mp4 (463MB) | mp3 (45MB)

    Today, I am pleased to announce the release of the National HIV/AIDS Strategy for the United States.  The release of the strategy reaffirms President Obama’s commitment to fighting this domestic epidemic.

    From the time that we first heard about the human immunodeficiency virus (HIV) thirty years ago through today, HIV has become a global pandemic with more than 33 million people living with HIV around the world.  In the United States, approximately 56,000 people become infected each year, more than 1.1 million Americans are living with HIV, and nearly 600,000 Americans have been lost to this disease.  Unless we take bold actions, we anticipate a new era of rising infection rates and even greater challenges in serving people with HIV.

  • Working to Break the Silence and Raise HIV/AIDS Awareness in Caribbean American Communities

    Caribbean American communities are incredibly diverse and have contributed greatly to the growth of this Nation.  I learned from watching my mother, who worked as a nurse taking care of sugar cane plantation workers, not only the importance of hard work and dedication but also the importance of family and community.  As a community, we face a significant challenge in tackling HIV. Even though Caribbean Americans comprise less than 10 percent of the total U.S. population, they are included in the disproportionately high rate of new HIV/AIDS diagnoses that occur in Black Americans. As a clinician and a professional in the field of public health, I have seen those challenges first hand. Yet as member of the community, I also know what we can accomplish if we work together. Caribbean American leaders can play an especially important role in the community to promote HIV awareness to address this public health issue. To help prevent HIV/AIDS, community leaders and care providers need to communicate about HIV in culturally relevant and linguistically appropriate ways.

    As with other racial and ethnic minority communities, many Caribbean Americans have taboos against discussing sexual matters related to HIV risk. There is stigma associated with men having sex with men in some Caribbean American communities, and this challenge may influence some individuals to avoid getting tested for HIV.  Delayed HIV testing and diagnosis among Caribbean Americans seriously endangers their health and the health of their sexual partners. We must be clear and open in discussing the risk factors associated with HIV and all work to reduce barriers to testing and treatment. With regular testing to identify new HIV infections, individuals who test positive can have the opportunity to receive appropriate care and treatment to prolong their lives and reduce the chances of infecting others.

    Federal partners including HHS have been working with the White House Office of National AIDS Policy (ONAP) to develop a National HIV/AIDS Strategy using input from the public, to improve our response to the epidemic in the U.S.  Active involvement by individuals and stakeholders including state, territorial, and local governments will be important in implementing the national strategy. The HHS Office of Minority Health will continue to partner with other agencies and organizations to support capacity building in hard-hit communities, improve care providers’ cultural competency, conduct outreach, and help people to get educated about HIV, get tested, and get treated. We are targeting those hardest hit by the epidemic for example, our HIV/AIDS Health Improvement for Re-entering Ex-Offenders Initiative (HIRE) program bridges healthcare gaps that exist with the AIDS epidemic to improve the HIV/AIDS health outcomes of ex-offenders re-entering the mainstream population by supporting community-based efforts to ensure their successful transition from state or federal incarceration back to their communities.

    Today, we recommit with others around the country to improve the lives of people living with HIV/AIDS. I learned a saying from my mother that not all silence is golden, and silence isn’t golden when it costs lives. On this Caribbean American HIV/AIDS Awareness Day, let’s raise our voices together to empower Caribbean American communities to challenge the stigma surrounding the disease in order to help reduce new infections and better serve people living with HIV. Let’s aim to reach our communities with a message focused on prevention and testing, understanding that if we work together we can continue to achieve great things, one of the greatest being an end to the HIV epidemic.  

    Garth Graham, M.D. is the Deputy Assistant Secretary for Minority Health at the U.S. Department of Health and Human Services.

  • White House Meeting on Black Men and HIV

    The toll of the HIV epidemic among Black men in the United States is staggering.  CDC estimates that 1 in 16 Black men will become infected with HIV in their lifetime.  An estimated two-thirds of people living with HIV/AIDS in the Black community are men, and Black men in some U.S. cities have HIV rates as high as heavily impacted countries in Africa. According to CDC, Black gay and bisexual men are the most heavily impacted population in the Black community.  One study in five major U.S. cities found that as many as half of all Black gay men in these communities were living with HIV. Although not as heavily impacted, Black heterosexual men are also at high risk for HIV infection through heterosexual sex and injection drug use. 

    On June 2, 2010, The Office of National AIDS Policy (ONAP) convened a meeting at the White House on Black Men and HIV.  The meeting included black men living with HIV, experts on HIV/AIDS, Federal, State, and local policymakers,  community-based service providers, representatives from foundations, and leaders from across the black community’s civil rights and faith organizations.  The purpose of the meeting was to raise awareness about the domestic HIV epidemic among Black men, discuss government and community responses to the epidemic, and promote a conversation among diverse elements of the Black community.  The meeting is part of a series of discussions that have been hosted by ONAP over the past year.  Past meetings have focused on HIV among women, youth, and other topics.

    Part of the reason why it is so important to re-energize the dialogue is that frequently discussions of HIV among Black men have had the effect of casting blame without spreading knowledge of the factors that cause Black men to be at heightened risk. To move forward, we need the public to have a deeper understanding of the complex issues that contribute to infections, and we need a more concentrated focus on solutions for supporting Black men and the other communities who bear a heavy burden of responding to HIV.

    The diversity of participants who attended the event was reflected in the diversity of opinion. Topics ranged from supporting faltering organizations engaged in HIV prevention work with Black men; HIV/AIDS awareness campaigns targeting Black men and education efforts at the Federal and community level; ongoing social pressures facing Black men; the role of the Black community and society at large in preventing HIV infection among Black gay and bisexual men, and how the HIV epidemic among Black men impacts Black women.  Please see the meeting agenda for more information on the speakers and meeting format. 

    As a scientist who has spent the last 10 years addressing this topic while at the Centers for Disease Control and Prevention, I believe that this type of dialogue is essential to improving our country’s response to HIV/AIDS.  This conversation needs to continue, but more importantly, it needs to be followed by collective action to end the national tragedy such that future generations of Black men do not face HIV infection as a rite of passage.  (For more information about HIV, go to )

    Gregorio Millett is the Senior Policy Advisor for the Office of National AIDS Policy.

  • World Hepatitis Day

    Today, May 19th we mark World Hepatitis Day. Hepatitis is a public health issue and impacts millions of Americans.  For many people, hepatitis often goes undetected and becomes increasingly difficult to treat over time.  Public awareness remains a critical factor in the prevention, detection and management of this disease and that there is a need to expand knowledge and eliminate hepatitis-related stigma among health care providers, at-risk populations, and the general public.  In honor of World Hepatitis Day, President Obama released the below Presidential Message:

    I send warm greetings to all those observing World Hepatitis Day.

    Millions of Americans are affected by viral hepatitis, and too many do not know they are infected. As a leading cause of liver cancer and related complications, viral hepatitis presents a major public health challenge at home and abroad. We must work together to raise awareness, increase access to services, improve preventive care, and end the silence surrounding this life-threatening illness so at-risk and infected individuals can receive the assistance they need.

    Across the United States, countless health care professionals, researchers, and advocates are working to achieve these goals, and our Nation’s future is more hopeful because of their dedication. Their tireless efforts are bringing us closer to the day when words like “incurable” are no longer a part of our vocabulary.

    On World Hepatitis Day, we renew our support for people living with hepatitis and their loved ones, and for those who are working to improve treatment and prevention. I wish you all the best as you join together to take action against this terrible disease.  

    Jeff Crowley is the Director of the Office of National AIDS Policy.