Office of National AIDS Policy Blog

  • CDC Expands Successful HIV Testing Initiative

    Today, the Centers for Disease Control and Prevention announced that we will be expanding our successful HIV testing initiative by $31.5 million, for another three years. The new total program funding  will be approximately $142.5 million over the next three years. This will reach more people with life-saving information on whether or not they are infected with the virus. Since the testing initiative began in 2007, more than 1.4 million Americans have been tested for HIV through this program and more than 10,000 people with HIV have been newly diagnosed.  The vast majority of these people were linked to care.

    We know that getting people tested and diagnosed is an important step in reducing new HIV infections.  Testing is the first step in linking HIV-infected people to medical care, ongoing support, and prevention efforts to help them establish and maintain safer behaviors.  In fact, studies show that once people learn they are infected with HIV, most take steps to protect their partners.
     
    However, far too many people in the U.S. are infected with HIV but unaware of their status. More than 200,000 people – or one out of every five people living with HIV in this country – may be unknowingly transmitting the virus to their partners.  Additionally, many people are diagnosed with HIV late in the course of infection, when treatment and prevention efforts cannot be maximized.

    The first three years of the initiative primarily focused on increasing testing and knowledge of HIV status among African American men and women. These groups bear an extremely disproportionate impact of HIV. The new three-year effort will reach even more populations at-risk for HIV, including gay and bisexual men of all races, Latinos, and injection drug users.  Thirty jurisdictions are eligible to apply for the new funding (an increase from 25 areas in the last cycle of funding), which represent the areas with the most severe HIV epidemics among these populations.  The first year of the expanded program will begin in September 2010.

    CDC is committed to ensuring that more Americans are tested for HIV, and where necessary, linked to appropriate care. This is critical among those vulnerable populations that need it the most—including those who don't have regular contact with the health care system. CDC has long been the nation’s leader in supporting testing efforts as a part of HIV prevention.  In 2006, we issued new recommendations to make HIV testing routine for all Americans, regardless of one’s risk for the virus. Our goal is to make HIV testing as routine as a blood pressure check. The testing initiative has helped to make those recommendations a reality in many health care settings, where opportunities to screen patients for HIV are often missed.  This program represents just one example of the ways that we can help state and local health care providers make testing routine and to identify more people who are infected but unaware of their status—and ultimately reduce the ongoing and unacceptable toll of HIV on this nation.

    More information is available about the funding announcement on CDC's website. To learn more about HIV and AIDS and find out where you can receive a confidential HIV test, visit www.hivtest.org , call 800-CDC-INFO, or text your ZIP code to “Know It” (566948).

    Kevin Fenton, M.D., Ph.D., is the director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP)

  • Together We Must Face the Challenge of HIV/AIDS in Native American Communities

    March 20, 2010 is the fourth annual National Native HIV/AIDS Awareness Day.  It is a day to renew our commitment to fighting HIV/AIDS and to challenge the stigma surrounding the disease by increasing awareness of the risk factors for infection.  I know that many people are uncomfortable talking about HIV and AIDS, but progress in the fight against HIV/AIDS depends on our knowing the basic facts about transmission as well as on increasing American Indian and Alaska Native (AI/AN) access to HIV testing and comprehensive health services. 

    Even though AI/AN HIV/AIDS cases comprise less than 1 percent of total cases in the U.S., AI/AN communities are disproportionately impacted by the disease.  American Indians and Alaska Natives have a 40% higher rate of AIDS than non-Hispanic white Americans, and the AIDS rate among Native women is 2.8 times that of non-Hispanic white women.  AI/AN communities experience significant health disparities and face high rates of substance abuse and sexually transmitted infections, which increase the risk of HIV transmission.  Additionally, many American Indians and Alaska Natives, like other Americans, do not know that they are infected and are therefore more likely to spread the disease.  Together, we must continue to expand access to confidential testing in both urban and rural areas.  As a Nation and within our Indian health system, our promotion of routine HIV screening combined with AI/AN community acceptance is helping to reduce stigma and confidentiality concerns.

    To be effective, HIV/AIDS prevention programs must also be culturally sensitive.  Current programs in Indian Country, therefore, are focusing on traditional teachings and the importance of community.  The Phoenix Indian Medical Center, Gallup Indian Medical Center and Alaska Native Medical Center are just a few examples of comprehensive HIV/AIDS programs involving HIV prevention programs and treatment and care services.  Smaller service units and urban facilities such as Pine Ridge, SD and South Dakota Urban Indian Health are also expanding HIV testing services and experiencing positive community acceptance - a much needed effect to help reduce stigma surrounding HIV. 

    In addition to increasing the availability of culturally sensitive HIV testing and prevention programs in rural communities, we must work to overcome the barriers keeping American Indians and Alaska Natives from obtaining needed care and treatment.  Towards that effort, the Indigenous HIV/AIDS Research Training (IHART) program, designed specifically for Indigenous and other underrepresented ethnic minority (UREM) scholars, mentors and trains AI/AN and UREM scholars to design culturally grounded research that will contribute to ameliorating health disparities among American Indians and Alaska Natives in the areas of HIV/AIDS, other sexually transmitted infections, and mental health.  The IHART program nurtures the grant making skills of AI/AN tribal, community, and university-based scholars and incorporates culturally specific Native epistemologies, methodologies, and research protocols.  Increasing the ranks of AI/AN and UREM scientists conducting culturally grounded research will generate information that can guide effective future prevention and intervention programs.

    The White House Office of National AIDS Policy (ONAP) is also joining the fight against the epidemic.  ONAP is currently developing a National HIV/AIDS Strategy with input from the public and from agency partners, including the Indian Health Service, to more effectively address the epidemic.  Participation from stakeholders, including tribal leaders, will be necessary to ensure that all affected populations benefit from the implementation of the National Strategy.  Together we must confront the high rates of poverty, drug use, mental health issues, high-risk sexual behaviors, and violence, which increase the risk of HIV transmission and limit individuals’ ability to access services.

    Raising awareness about HIV/AIDS is only the first step in overcoming this public health crisis.  Today, we honor the efforts of those working to improve the lives of AI/AN people living with HIV/AIDS, including the dedicated staff at IHS, tribal, and urban Indian health facilities. 

    As we move forward, it is important that we continue to empower AI/AN communities in rural and urban areas to reduce new infections and increase the availability and accessibility of culturally competent care.

    Kimberly Teehee is Senior Policy Advisor of Native American Affairs for the White House Domestic Policy Council

  • March 10 -- Redoubling Our Efforts on National Women and Girls HIV/AIDS Awareness Day

    Today, we commemorate the 5th annual National Women and Girls HIV/AIDS Awareness Day.  Yesterday, I had the opportunity to participate in a briefing held by the National Alliance for State and Territorial AIDS Directors (NASTAD) and the HHS Office on Women’s Health with important leaders in Congress.  The event highlighted how the domestic epidemic is affecting women and how much we need to maintain our commitment to addressing this public health issue. 

    Women and Girls HIV/briefing

    (Left to right) Moderator Rosie Perez, Dr. Howard Koh (HHS), Tina Tchen (White House Council on Women and Girls), Janet Cleveland (CDC) and Amna Osma (Michigan Department of Community Health) participate in a briefing on HIV/AIDS and women, March 9, 2010. (by Maggie Chen)

    The statistics are sobering:  Every 35 minutes, a woman tests positive for HIV in the United States.  While women in the U.S. represented 8 percent of AIDS diagnoses in the 1980’s, they now account for 27 percent.  The HIV epidemic in the U.S. disproportionately impacts women of color:  HIV/AIDS is one of the leading causes of death among black women and Latinas.  Compared to white women, the AIDS case rate is 5 times higher for Latinas and 20 times higher for black women.  Clearly, we must redouble our prevention efforts as well as improve care and treatment for women living with HIV. 

    It is imperative that HIV prevention efforts take into account the way in which many women in the U.S. become infected with HIV, as more than 80 percent of HIV/AIDS cases among women and teenage girls are attributable to heterosexual contact.  It is also important to increase access to female-controlled prevention methods, such as the female condom, and to develop effective microbicides and vaccines.

    The Office of National AIDS Policy (ONAP) is leading a team of Federal Agency partners to develop a National HIV/AIDS Strategy and strengthen our nation’s response to the domestic epidemic.  Working with a wide range of stakeholders such as state and local governments, businesses, faith communities, service providers, and others will be critical to implementing the national strategy.  

    Since the beginning of the epidemic, there have been significant reductions in mother-to-child transmission of HIV in the U.S. Research has also shown that progress is possible through targeted prevention programs that are effective in reducing risky behaviors among HIV-positive and HIV-negative women.  But there is still work to be done, a major piece of which is enacting reforms to our health insurance system that will expand access to care. Key to these reforms are making preventive care accessible and ensuring that Americans, including women living with HIV, are not excluded from being insured due to a preexisting condition.

    As we move forward, it is not only crucial to increase the number of women and girls who know their status, but also, through interventions that increase self-esteem, the number of women and girls who know their self-worth and have tools to make healthy decisions.
     
    Tina Tchen is the Director of the White House Office of Public Engagement and Executive Director of the Council on Women and Girls

  • ONAP Announces Federal Interagency Members Developing National HIV/AIDS Strategy

    This event has concluded. See a video of the event below.

    Download Video: m4v (359MB)

    On Wednesday, February 24th, from 2:00-3:45pm, the public will have an opportunity to hear more about our progress to date and the process that the interagency working group is following to develop the National HIV/AIDS Strategy, as well as meet the members of the interagency working group. The meeting is hosted by the White House Office of National AIDS Policy (ONAP) and the Office of Public Health and Science (OPHS) at the U.S. Department of Health and Human Services.  The meeting is not a community discussion, but designed to give the public an opportunity to hear what has already taken place and our next steps in developing the strategy.  (See an agenda of the meeting.) 

    Although the United States has among the worst HIV epidemics among industrialized nations, the US has never adopted a coordinated nationwide response to address the epidemic.  President Obama is committed to addressing HIV in the United States and has tasked the White House Office of National AIDS Policy, under the direction of Jeffrey Crowley, to develop a National HIV/AIDS Strategy.  The President articulated three goals for the strategy:

    1. Reduce the number of new HIV infections (HIV incidence);
    2. Increase access to care for people living with HIV and optimize health outcomes; and
    3. Reduce HIV-related disparities.

    The strategy will not be a comprehensive catalog of all of the things we need to respond to the HIV epidemic. Rather, the strategy is an opportunity to identify a small number of high payoff action steps that can shift and improve our nation’s response to HIV/AIDS in order to achieve the President’s goals.

    In order to develop the strategy, we first solicited feedback from community partners across the country last August through December.  In the second phase of developing the strategy, we completed formation of a federal interagency working group at the beginning of this year. The group includes influential leaders from Departments and Agencies across the US government, and includes subcommittees devoted to each of the President’s three goals for the strategy. HIV and AIDS require a medical response and the Assistant Secretary for Health (Dr. Howard Koh) of the Department of Health and Human Services (HHS) serves on the interagency working group, as well as other crucial HHS employees and representative from HHS agencies.   But one thing that has become abundantly clear over the course of the epidemic is that tackling HIV and AIDS requires more than a medical response.  That is why the interagency working group also includes members from the Department of Housing and Urban Development, the Department of Justice, the Department of Labor, the Social Security Administration and other government entities. Moreover, ONAP is consulting with key officials at additional Departments and Agencies that could not formally participate on existing interagency committees to address gaps on topics critical to the development of a successful National HIV/AIDS Strategy.

    We understand the importance of community feedback.  From the beginning, we opened up the strategy development process in an unprecedented manner by holding 14 community discussions across the country, as well as soliciting recommendations from the White House website to hear directly from you.  In order to keep the community engaged in the process, we also decided to hold a public meeting with our interagency working group members this week. 

    As we realize not everyone will be able to attend the February 24th meeting, we will have meeting notes available on AIDS.gov.  This is one of many steps taken to ensure the public’s voice is heard throughout this process and we look forward to seeing many of our community partners, as well as other partners during the meeting and hope that you are able to welcome our interagency members in person.

    Gregorio Millett is a Senior Policy Advisor in the White House Office of National AIDS Policy

  • Responding to Concerns Over Ryan White Emergency Housing Policy

    The Health Resources and Services Administration (HRSA) announced today that it is rescinding enforcement of its 24-month cumulative cap on short-term and emergency housing assistance under the Ryan White program. This is a temporary step pending a broader review of Ryan White housing policies.  See the announcement in the Federal Register.

    Late last year, I became aware of growing community concern over the impact of this policy, especially as the date (late March) was approaching when the first persons subject to this limit faced the possibility of losing their housing.  In December, I met with a number of HIV community advocates who shared their concerns with the perceived inflexibility of this policy.  The situation is compounded by the difficult economic situation.  The need for housing assistance exceeds the available resources in many communities in the best of circumstances, but is further constrained by tight local and state budgets as the country works to recover from the most serious economic downturn in many peoples’ lifetimes. 

    In October, the President signed into law the fourth reauthorization of the Ryan White program.  This is a strong law that underscores the ongoing commitment of the Administration and the Congress to provide for the care and treatment of people living with HIV/AIDS.  The HIV/AIDS Bureau, under the leadership of Deborah Parham Hopson, is determined to implement the law and ensure that resources are effectively deployed to provide critical medical care and supportive services to people living with HIV/AIDS across the country. 

    Numerous studies have demonstrated the positive and essential role of housing in ensuring that people living with HIV/AIDS come into care and stay in care. Recognition of this link provides a basis for Ryan White supporting short-term, emergency housing assistance.  At the same time, the Ryan White program is intended to primarily support primary medical care and related health care supports.  The Department of Housing and Urban Development (HUD), and in particular the Housing Opportunities for People with AIDS (HOPWA) program, has lead responsibility for providing housing assistance to people with HIV/AIDS.  Going back through many Administrations, the role of Ryan White in providing housing supports has always been understood to be limited to short-term and emergency assistance.  We are not currently contemplating any expansion of Ryan White’s role beyond providing short-term emergency assistance. 

    I have heard the community concerns and believe it is important to ensure that our implementation of this policy reaches an appropriate balance that achieves several goals: it should strengthen linkages to HUD programs and state and local housing resources for providing longer-term assistance; it should minimize housing disruptions for people living with HIV/AIDS; it should integrate housing with a broader range of supports that collectively can support individuals in maintaining their health; it should provide flexibility to respond to exceptional circumstances; and it should minimize the burden on Ryan White providers who are responsible for assisting us in implementing any housing policy.  Administering the Ryan White program is an important responsibility that necessarily entails making difficult choices as we respond to multiple and competing needs of people living with HIV/AIDS all over the United States. As I work with the HIV/AIDS Bureau to undertake a comprehensive review of Ryan White housing policies, I look forward to the continued insights and perspectives of people living with HIV/AIDS, housing experts, and our network of local, state, and community-based partners.

    Mary Wakefield, Ph.D., R.N. is the Administrator of the Health Resources and Services Administration (HRSA)

  • Administration Funds New HIV Prevention Initiative Targeting Gay and Bisexual Men

    Earlier this week, the President released his budget proposal for FY 2011.  Although the President’s budget proposes to freeze non-security spending, it provided an increase of $71 million in prevention and care for people living with and at risk for HIV/AIDS. 

    The budget makes clear that HIV/AIDS remains a priority. (More details about the budget can be found at on the FY2011 Budget HIV/AIDS Fact Sheet). One notable feature of the budget is a new initiative to prevent HIV infection among gay and bisexual men.  This is welcome news.  Thirty years into the domestic HIV epidemic, gay and bisexual men remain disproportionately affected by HIV.  Although HIV diagnoses have remained flat or declined in most risk groups between 2004 and 2007, HIV diagnoses have increased among gay and bisexual men.  The impact of the epidemic on this group is staggering.  Last August, CDC released preliminary estimates showing that gay and bisexual men were 50 times more likely than all other risk groups to contract HIV.    Although gay and bisexual men  represent approximately three percent of the United States population, they account for 53% of new HIV infections.  The distribution of HIV infection is not uniform across gay and bisexual men by race or ethnicity.  White gay men comprise the greatest number of HIV diagnoses among all gay and bisexual men.  However, blacks and Latinos are much more likely than white men to be infected with HIV and represent the greatest proportion of HIV diagnoses among younger gay men (ages 13-24).

    This new initiative reflects a commitment to use epidemiological data to better target our HIV prevention resources to the populations at greatest risk for HIV infection.  HIV prevention funds have never adequately targeted gay and bisexual men. The President’s budget devotes nearly $17 million to fund an HIV prevention initiative, and approximately $10 million for prevention of viral hepatitis and other STIs among gay and bisexual men.  The initiative will scale up effective biomedical and behavioral interventions to reduce the risk of acquiring and transmitting HIV, as well as efforts to increase regular HIV testing among gay and bisexual men.  Additionally, funds will be used to provide technical assistance to improve HIV case surveillance with all populations, including those with lower rates of HIV incidence such as Asian and Pacific Islander and Native American and Alaska Native communities.  Last, the new initiative will direct resources to social marketing efforts and update risk reduction messages for gay and bisexual populations.

    Gay and bisexual men are not the only sexual minorities impacted by HIV/AIDS. Transgender populations are also at elevated risk for HIV infection, but HIV prevention resources directed to this group have lagged historically.  During the HIV/AIDS Community Discussions that the Office of National AIDS Policy) held across the country, we heard that transgender populations are rarely targeted for HIV prevention programs and are lumped with gay men, or even ignored altogether.  This is unfortunate given that a significant proportion (as many as 27%) of transgender participants across various studies test HIV-positive.  For this reason, part of the increase in HIV prevention funds will be used to support activities that target the transgender community.

    Throughout his Administration, the President has attempted to ensure that our policies and programs are guided by the best data describing the challenges we face and the best evidence of what works effectively.  As with our important investments in responding to HIV/AIDS in the African American and Latino communities through the Minority HIV/AIDS Initiative, investments in HIV prevention for gay and bisexual men are part of a concerted effort to focus our resources where they are most needed and deploy critical public resources where they will have the greatest effect. 

    Greg Millett is the Senior Policy Advisor in the Office of National AIDS Policy