The White House released its new National HIV/AIDS Strategy during a press conference yesterday. President Obama announced at the press conference that the Strategy has three goals: “Reducing new HIV infections; improving care for people living with HIV/AIDS; [and] narrowing health disparities.”

The President added that the Strategy “is the product of conversations with HIV-positive Americans and health care providers, business leaders, faith leaders, and the best policy and scientific minds in our country.”

The National HIV/AIDS Strategy is meant as a plan and guideline for policy makers and the general United States public.

Several specific targets set forth by the Strategy to achieve its three goals by 2015 include:

• Decreasing the number of new HIV infections by 25 percent
• Decreasing the rate of HIV transmission by 30 percent
• Increasing the number of people with HIV who know their HIV status from 79 percent to 90 percent
• Increasing the number of Americans who get treatment within three months of diagnosis from 65 percent to 85 percent
• Increasing the number of Ryan White program members with permanent housing from 82 percent to 86 percent
• Increasing the number of gay and bisexual men, African-Americans, and Latinos with undetectable viral loads by 20 percent.

Kathleen Sebelius, Secretary of Health and Human Services, told reporters in a press conference that these targets were “ambitious but reachable” goals.

“The United States should be a place where new HIV infections are rare. When they do occur, every person – regardless of age, gender, race/ethnicity, sexual orientation, gender identity, or socio-economic circumstance – will have unfettered access to high quality, life-extending care, free from stigma and discrimination,” she added.

Implementation Of The Strategy

The National HIV/AIDS Strategy relies mostly on existing programs and funding, including the Ryan White Act and the recently passed health care reform, the Affordable Care Act.

“There are constraints on the magnitude of any potential new investments in the Federal budget,” wrote officials in the Strategy’s Executive Summary. “The Strategy should be used to refocus our existing efforts and deliver better results to the American people within our current funding levels, as well as to highlight the need for additional investments.”

Officials emphasized the need for greater collaboration between programs, and between federal and state governments, to make current HIV/AIDS programs more efficient.

“We want to make sure that our prevention and treatment resources reach the most vulnerable Americans, especially in communities with the greatest need,” said Secretary Sebelius.

The Strategy proposes that HIV/AIDS funding be given to states according to the number of people living with HIV. According to the 2008 Surveillance Report, the majority of individuals diagnosed with AIDS in 2008 were living in urban areas with more than 500,000 people.

To determine which states are most in need, the plan also encourages communities to track and report viral loads (amount of HIV in the blood) and CD4 (white blood cell) counts in higher-risk populations.

A total of $30 million in funding has been allocated to establish the new policy outlined in the Strategy.

The Strategy also focuses on specific goals for improving HIV and AIDS care:

• The Health Resource and Services Administration (HRSA) is expected to work with states and medical providers to make sure that treatment and care is available to HIV patients soon after diagnosis. HRSA will also work on providing patients with information on how to access health care and support services.
• The government will promote and expedite Medicaid waivers, which will allow states to expand their Medicaid programs to cover pre-disabled people living with HIV.
• The federal government will also encourage HIV-specific training in medical, dental, pharmacy, physician assistant, nurse practitioner, social work, and nursing school programs to increase health care options for people with HIV.

President Obama’s Strategy also aims to decrease the stigma against people with HIV and promote HIV-awareness and tolerance. “As part of this strategy, we will continue to look for concrete ways to reduce the stigma associated with HIV and AIDS,” said Secretary Sebelius.

States will be urged to drop laws that are considered discriminatory, such as those that make spitting or biting by HIV-positive individuals a crime. Scientists have shown these carry minimal risk of transmitting the virus.

The federal government also intends to recruit faith leaders to support people with HIV and promises to better uphold anti-discrimination laws.

The plan calls for input and support from businesses and communities to help implement the Strategy.

“We have to work in partnership with every sector,” said Melody Barnes, White House Domestic Policy Council Director. “The federal government brings a lot to the table, but we recognize that state and local governments, the private sector, [non-governmental organizations], the philanthropic sector – all bring expertise and resources and knowledge and experience.”

“We believe it really is an all-hands-on-deck moment. We can all learn from each other, and we can all leverage each other,” she added.

The Office of National AIDS Policy will publish an annual report on the government’s overall progress.

Reaction To The New Strategy Is Mixed

Reaction to President Obama’s National HIV/AIDS Strategy has been mixed, with some AIDS advocacy organizations expressing dissatisfaction and disappointment.

The AIDS Healthcare Foundation criticized the Strategy for failing to provide enough funding and said the plan was too vague and lacked direction.

“This strategy is a day late and a dollar short: 15 months in the making, and the White House learned what people in the field have known for years. There is no funding, no ‘how to,’ no real leadership,” said Michael Weinstein, President of AIDS Healthcare Foundation, in a press release.

The Foundation also criticized the President for failing to fulfill the strategies previously recommended by the Centers for Disease Control (CDC) in 2006.

“Under President Obama, the CDC’s landmark – and prudent – 2006 guidelines recommending routine testing for HIV for all those ages 13 to 64 have also not been implemented nor even really prioritized,” said Weinstein.

AIDS advocates have estimated that an additional $126 million will be needed to cover funding gaps in HIV/AIDS programs. The $30 million provided in the Strategy has been called “a step backward.”

“Unless [President Obama] commits significant new resources intended to make major inroads against the spread of HIV, he will be regarded as a leader who did next to nothing about the most devastating epidemic of our time,” said Charles King, President and CEO of Housing Works in a press release.

Housing Works is a community organization that advocates for housing and other services for those with HIV and AIDS in New York City.

Despite these criticisms, Michael Saag, chair of the HIV Medicine Association, praised the National HIV/AIDS Strategy.

“The HIV Medicine Association applauds the Obama administration’s release of a National HIV/AIDS Strategy that signals a strengthened national commitment to real and sustained success in the battle against HIV/AIDS,” he said in a press release.

Kevin Carmichael, co-chair of the Ryan White Medical Providers Coalition, was also enthusiastic about the Strategy and the “robust implementation plan,” saying that they “applaud the administration’s commitment to develop this coordinated approach and hope this impressive level of commitment will be sustained in the implementation phase.”

For more information, please see the National HIV/AIDS Strategy (pdf) and the Implementation Plan (pdf).

Full audio (13 minutes) of President Obama’s press conference  (also available for download in mp3 format, 9.0 MB):

Full audio (48.5 minutes) of the Department of Health and Human Services press conference (also available for download in mp3 format, 33.3 MB):