Office of National AIDS Policy Blog

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

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    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

  • Let’s Make National Black HIV/AIDS Awareness Day a Day of Action

    February 7, 2010 marks the tenth annual National Black HIV/AIDS Awareness Day. 

    The Centers for Disease Control and Prevention estimates that there are 1.1 million people living with HIV in the United States (U.S.).   Despite representing 12% of the population, African Americans account for nearly half of all people living with HIV in the U.S. African Americans also account for a disproportionate number (46%) of the 56,000 new HIV cases that take place in the U.S. each year.  Black gay men and black heterosexual women comprise the second and third (respectively) largest number of new HIV infections across all racial groups in the U.S. each year.  HIV remains the number one killer of black women between the ages of 25 and 34, and CDC estimates that nearly half of all black gay men are infected with HIV in major metropolitan areas.  

    National Black HIV/AIDS Awareness Day is a chance to get more involved in getting the word out that HIV is preventable and treatable. With greater awareness about how the disease is spread and how to avoid risky behaviors, people can reduce their chance of infection. With appropriate treatment and medication, people living with HIV can live long and productive lives and manage their disease like other chronic illnesses.  That’s why it’s so important for everyone to get screened for HIV and to know their HIV status. 

    One important way that the President has shown his commitment to strengthening our national response to HIV/AIDS in America is through the White House Office of National AIDS Policy’s work in leading the development of a National HIV/AIDS Strategy.  The goals of the Strategy are to reduce new infections, increase access to care, and reduce HIV-related disparities.  Also, the President’s Budget request for FY 2011 includes $428 million for the Minority AIDS Initiative, an increase of $7 million, to address the disproportionate impact of the disease on minority communities.       

    National Black HIV/AIDS Awareness Day is a time to remember the men, women, and children who have been affected by the disease, and it’s a time to get more involved in ensuring that more people learn the facts about HIV/AIDS.  With better understanding, we can reduce the unnecessary stigma around the disease in African American communities, and people can feel better about taking action to know their status and get linked to appropriate care and treatment.  

    National Black HIV/AIDS Awareness Day is not only a time for remembrance, but a time for action.  If you are HIV-positive and not in care, take steps to learn how to get connected to care.  You can look online at www.aids.gov for federal resources and information that are available to you.  If you do not know your status and have not been tested recently, it’s easy to find information about where to get an HIV test.   Call1-800-CDC-INFORMATION, or send a text message to “KNOWIT” (566948) with your ZIP code to receive a list of HIV testing sites near you. 

    Adelle Simmons is a Policy Advisor in the Office of National AIDS Policy

  • ONAP Examines Linkages Between HIV and Housing

    The Office of National AIDS Policy (ONAP) has been traveling around the country holding a series of HIV/AIDS Community Discussions.  We just completed the fourteenth and final community meeting in Caguas, Puerto Rico.  One theme that many participants raised is the need to expand access to safe and affordable housing.  Over and over again, people made the connection between housing and HIV prevention, and between housing and effective HIV treatment.  Given these concerns, the role of housing will be a critical issue in the National HIV/AIDS Strategy (NHAS).

    Key questions include the following: Are the housing challenges facing people living with HIV/AIDS primarily a consequence of the nation’s broader housing issues, including the tightening of financial credit?  Are these challenges unique to persons with HIV/AIDS or do persons with other chronic diseases share similar experiences?  Given where we are now, what are the strategic steps we can take to make progress in expanding access to housing services? 

    To help answer these questions, ONAP held a meeting with key housing stakeholders last Thursday, December 17, 2009.

    During the HIV and Housing meeting, key Administration officials affirmed the President’s commitment to further explore the relationship between HIV and housing – and to strengthen services that support stable housing, which impacts people’s ability to access life-saving care and treatment.  Assistant Secretary of Housing and Urban Affairs (HUD) Mercedes Marquez detailed the steps HUD is taking to create a more responsive system that offers easier access, monitors results, and is efficient and accountable.  She outlined a more seamless approach to housing assistance service delivery not only within the framework of the HUD program, Housing Opportunity for People with AIDS (HOPWA), but with other programs accessible to people living with HIV/AIDS. 

    Derek Douglas, Special Assistant to the President for Urban Policy, and Adolfo Carrion, Director and Deputy Assistant to the President, Office of Urban Affairs, described how housing policy fits into a broader conversation that includes education, transportation, economic development and other services that impact people living with HIV/AIDS.  Charles King, President and CEO of Housing Works, an HIV/AIDS housing advocacy organization, pointed out the historic nature of this meeting – a meeting on HIV and Housing within the White House  and spoke of the opportunity to improve the lives of people with HIV/AIDS by ensuring access to housing.

    Participants then quickly got to work on developing a series of recommendations for the NHAS.   There were three issue specific breakout sessions - Housing as HIV Prevention and Care, Bringing Successful Strategies to Scale, and the Role of Housing in Systems of HIV Care – each led  by issue experts from community based organizations, academia, service providers, state legislators, and private industry. Draft recommendations were summarized during a report back period.  These recommendations will be revised during follow up conference calls. 

    On a personal note, I have seen the positive impact of housing in the lives of people with HIV/AIDS.  Prior to moving to Washington, DC, I directed an emergency shelter/hospice for HIV/AIDS patients in Puerto Rico.  A fair number of our patients, many of them John/Jane Doe’s, were the product of “patient dumping” where healthcare providers often discharged patients with little planning, often leaving them homeless and on the streets without care or anyone to look out for them because housing support was not available.  After a few months under our care (albeit palliative, end of life care), most achieved a far better quality of life before succumbing to their terminal illness.  And a few recovered and were placed in more permanent housing.  Our efforts  certainly testify to the strong restorative bond between accessible housing and HIV/AIDS prevention, treatment and care. 

    The HIV and Housing meeting was an exciting event that brought together impassioned advocates with leading government officials, both committed to finding common ground and providing meaningful guidance to ONAP and the NHAS effort.

    James Albino is the Senior Program Manager in the Office of National AIDS Policy

  • Passing the Senate Health Reform Bill: One Big Step Forward for People Living with HIV/AIDS

    More than most groups, people living with HIV/AIDS have a lot at stake in ensuring that Congress enacts comprehensive health insurance reform right away.   People living with HIV are more likely to be uninsured than other Americans.  They are more likely to receive substandard care from being underinsured or because of high cost-sharing and other barriers to quality care.  And, research tells us that uninsured people living with HIV are likely to learn their HIV status and come into care later than others…which means missed opportunities for protecting their health and missed opportunities for preventing the spread of HIV.

    Enacting comprehensive health reform as a means of expanding access to care for people living with HIV has been a top priority of the HIV community for many years. We have never been closer to achieving this significant milestone.  The House of Representatives has passed its bill, which does many important things to improve health insurance coverage for people living with HIV.   Two committees of the Senate have passed bills, and Majority Leader Reid has been working to craft a bill that can attain the needed 60 votes in the Senate.  Recently, some disheartened and passionate advocates have asserted that the Senate bill does not do enough and that it should not be enacted.   I believe an objective analysis of the current situation and the improvements in health coverage that will come about if the Senate bill were enacted demands that we forcefully counter this self-defeating perspective. 

    Don’t get me wrong…I understand the desire to push for more, but to quote President Clinton’s recent comments on this issue, “America can't afford to let the perfect be the enemy of the good.”  I fully understand the desire to ensure that the bill sent to the President does as much as possible to expand coverage, lower costs, and improve the quality of care.  Despite its critics, however, the Senate bill makes solid progress on all of these measures and the Senate’s vote on its bill is not the end of the process.  Advocates for people living with HIV can and should continue to push for provisions in the House bill that they support.  They can and should also push for technical changes that could clarify the intent of policies affecting people living with HIV.  Collectively, we must work to make the final legislation as protective of people with HIV as possible…while making sure that every step of the way we are moving forward and rejecting the arguments of those who want to keep things the way they are.  For people living with HIV, the status quo is the ultimate nightmare scenario.

    For years, the HIV community has called for expanding Medicaid as a strategy for expanding insurance coverage for people with HIV.  In particular, there has been recognition that the current disability standard for Medicaid and other public programs that keeps most people with HIV from becoming eligible for Medicaid until they have an AIDS diagnosis is a serious problem.  The Senate would expand Medicaid to all people up to 133% of poverty.   The importance of this single provisioncannot be overstated.  This is huge. 

    People living with HIV bear the burden of having a highly stigmatized disease and they regularly face discrimination simply on the basis of their health status.  They also are particularly vulnerable to pre-existing condition exclusions.  Several years ago, a former colleague, Karen Pollitz (a researcher at the Georgetown University Health Policy Institute) and others, did a study for the Kaiser Family Foundation where they constructed seven hypothetical applicants for individual insurance coverage in 8 insurance markets across the country.  In these markets, there were a total of 60 insurance options available.  One of the striking, but not surprising findings of their work was that the applicant with HIV was denied coverage every single time.  The Senate bill, along with the House bill, would outlaw this type of discrimination by eliminating pre-existing condition exclusions.
     
    People living with HIV are also especially cognizant of the barriers to care posed by unreasonable cost-sharing even when they have insurance.  On average, antiretroviral therapy costs between $12,000-$15,000 per person per year.  When we add in the cost of anticholesterol medications, anti-hypertensives, prophylactic drugs to prevent other infections, and other prescription medications, the average drug costs for people living with HIV rise even higher.  Even co-payments of $25 per prescription may seem reasonable to many people, but they become a bigger burden for people with HIV who may be filling ten prescriptions per month.  These same individuals may also face significant co-payment burdens from seeing multiple providers.  Reforms in the Senate and House bills will impose annual out-of-pocket caps, for the first time placing an upper limit on what individuals with high-cost chronic conditions will have to pay out-of-pocket.

    These are just some of the many very significant improvements that are within reach. We can see the light at the end of the tunnel.  While people living with HIV and their advocates should continue to advocate for the best policies, let’s not lose sight of the very major improvements in access to and quality of health care for people living with HIV that will be a reality when the President signs into law health reform legislation.  Now that we are this close to achieving our long sought goal of affordable coverage for people living with HIV/AIDS, we need to work as hard as we can to cross the finish line.

    Jeffrey S. Crowley is the Director of the Office of National AIDS Policy and Senior Advisor on Disability Policy