The White House has released an updated version of its National HIV/AIDS Strategy, outlining the administration's plans through the year 2020. In keeping with recent research, the revised strategy includes an increased emphasis on early HIV treatment and pre-exposure prophylaxis, or PrEP, and focuses on heavily affected groups including young gay men, transgender women, and African-Americans.
President Barack Obama launched the strategy update at a July 30 event at the Morehouse School of Medicine in Atlanta, a city that represents the burgeoning HIV epidemic in the South.
"Prevention, treatment, and care have saved millions of lives, even in the world's poorest countries," Obama said. "But our work is far from finished. One in eight people with HIV still go undiagnosed. Only three in 10 people with HIV have suppressed the virus in their system, lowering it to an undetectable level. And this disease still affects different ages, races, sexual orientations, and even different regions of the country in disproportionate ways."
Response to the strategy has generally been positive in San Francisco and elsewhere.
"Over the last five years, the field of HIV has experienced breakthrough advances in testing, prevention, and access to treatment," said San Francisco AIDS Foundation CEO Neil Giuliano. "Since the first National HIV/AIDS Strategy was released, we've learned that early treatment gives people better health outcomes, that treatment equals prevention, and that PrEP works. HIV remains a major health issue in our country and the update �" reflecting hard work and national leadership �" leverages new evidence and acknowledges the vast work still to be done."
Strategy specifics
The National HIV/AIDS Strategy, initially released in 2010, sets forth a vision: "The United States will become a place where new HIV infections are rare, and 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."
To this end, the strategy includes four key goals: reducing new HIV infections, increasing access to care and improving health outcomes for people living with HIV, reducing HIV-related disparities and health inequities, and achieving a more coordinated national response.
Mirroring UNAIDS' "90-90-90" targets and San Francisco's "Getting to Zero" initiative, the strategy calls for improvements at every step of the HIV cascade of care, from testing and linkage to care to achieving undetectable viral load.
Specific targets in the strategy include increasing the percentage of people with HIV who know their serostatus to at least 90 percent, reducing the number of new diagnoses by at least 25 percent, increasing the percentage of newly diagnosed people linked to HIV medical care within one month to at least 85 percent, increasing the proportion of HIV-positive people with viral suppression to at least 80 percent, and reducing the death rate among people with HIV by at least 33 percent.
"We are pleased that the updated National HIV/AIDS Strategy aligns well with the Getting to Zero effort in San Francisco," Susan Buchbinder, director of Bridge HIV at the San Francisco Department of Public Health told the Bay Area Reporter. "Each of the San Francisco Consortium's first-year signature initiatives �" PrEP scale-up, rapid linkage to care after HIV diagnosis, retention in care, and elimination of HIV stigma �" are highly featured in the national strategy. We are at a turning point in the HIV epidemic �" we now have highly effective treatment and prevention, and the potential for health care access for all."
Response to the strategy
While the updated National HIV/AIDS Strategy has generally been well received, stakeholders have emphasized the need for action �" and the funds to carry it out �" not just talk.
"The updated National HIV/AIDS Strategy comes on the heels of important clinical trial findings confirming the significant benefits of antiretroviral drugs for HIV treatment and prevention," said HIV Medicine Association Chair Adaora Adimora. "This evidence must drive the [strategy] and move us to ensure access to HIV prevention, care and treatment for all people with HIV �" regardless of who they are or where they live.
"While scientific advances inspire optimism, the path forward is complicated by stigma, discrimination, complex social factors, challenges to the Affordable Care Act and Medicaid, and federal budget austerity measures," she continued. "Limited access to and poor uptake of approved medications for HIV prevention, late HIV diagnosis, late entry into care, and poor retention in care significantly hamper our ability to decrease new infections and achieve the optimal outcomes we all want for people already living with HIV."
One area where resources are not meeting the need is housing. The strategy acknowledges that stable housing both helps people remain HIV-free and makes it easier for those who are HIV-positive to stay in care and benefit from treatment. The update includes a target of reducing the percentage of people with HIV in medical care who are homeless to no more than 5 percent.
"Homelessness prevention is one of those rare social needs where there is a simple cure: money," AIDS Housing Alliance/San Francisco Director Brian Basinger told the B.A.R. "San Francisco needs to devote more resources targeting prevention of homelessness for all people, especially those who are HIV-positive and those who are at the highest risk of acquiring HIV, such as gay men and transgender women. Housing subsidies have been proven to substantially lower the behavior that can lead to the transmission of the virus."