During the presidential election of 2008, a coalition of organizations and individuals throughout the nation united in a call for the next president to commit the next administration to the development of a National AIDS Strategy. Both candidates agreed to the development of this comprehensive plan to address the domestic HIV/AIDS epidemic.
That call to action was simple. It stated that the United States must develop what it asks of other nations it supports through the President's Emergency Plan for AIDS Relief in combating AIDS – a national strategy to achieve improved and more equitable results.
President Obama has reiterated his commitment to a National AIDS Strategy since being sworn into office and has made the development of the strategy a top priority for Jeffrey S. Crowley, MPH, the director of the White House Office of National AIDS Policy.
The reasons for developing an effective national plan are clear: there is a new HIV infection in the U.S. every nine minutes; there has been no reduction in incidence in eight years; one in five people living with HIV in the U.S. do not know their status; only half of people living with HIV are in care; only half of those who qualify for antiretrovirals receive them; and severe disparities exist related to race, ethnicity, gender, sexual orientation, and regional variations.
There is consensus that the strategy should not simply be a list of recommendations, but rather an operational plan for the federal government that sets priorities and identifies opportunities to have maximum impact.
Mr. Crowley has stated on a number of occasions that President Obama has articulated three overarching goals for a National AIDS Strategy: 1) Reduce incidence of HIV; 2) Ensure access to care and treatment; and 3) Eliminate health disparities based on race, ethnicity, gender, sexual orientation, and regional differences.
On May 28, a diverse group of more than 80 community members came together at a roundtable discussion in San Francisco to offer ideas about the development of a National AIDS Strategy. The event was sponsored by the Coalition for a National AIDS Strategy, the San Francisco AIDS Foundation, Project Inform, Stop AIDS Project, and the Asian Pacific Islander Wellness Center and supported by more than a dozen other organizations.
At the San Francisco roundtable, participants tackled these three goals for the National AIDS Strategy and came up with an array of ideas that they felt were important to address while developing the strategy. The roundtable sponsors are crafting a report to provide the White House with the input from the participants at this event. The report will also be available to the community on the sponsors' Web sites.
While the plethora of ideas that came from small group discussions at the roundtable have not yet been fully examined, some important thoughts were articulated at the wrap up session and can be reported on now.
Across the board, participants agreed that it is vital that we not reinvent the wheel. Since many other countries have national strategies, it was strongly suggested that these strategies be examined. Other national strategies that the United States may have for other programs should also be evaluated. It was clear that participants felt strongly that research, both medical and social, need to be a component of each of the president's three goals and that issues surrounding stigma should also be addressed within all of these goals.
The president has committed to base a national HIV/AIDS policy on "sound science." The participants universally agreed that part of that commitment would be lifting the ban on federal funds for syringe exchange and that it would be vital to develop comprehensive and science-based sex education to counteract the impact of years of focusing on abstinence-only programs. There was also agreement that there needs to be a serious focus on research in people of color communities in order to develop effective prevention interventions and address health care disparities.
Some other important suggestions included ensuring universal free HIV testing as part of any health care reform effort, affordable diagnostic testing to help patients work with their health care providers to craft the best possible drug regimen for them, a national standard of care for HIV case management, providing higher educational opportunities for diverse communities so that there are an adequate number of healthcare providers that reflect the diversity of the HIV epidemic, and ensuring that access to care is available to marginalized communities.
The San Francisco roundtable is just one of a number of community meetings throughout the country to provide ideas for a National AIDS Strategy. Another Bay Area roundtable is being planned for July in Oakland. The Coalition for a National AIDS Strategy will take the input from these events to the White House. The coalition will also work with the Obama administration, while holding them accountable, to ensure that there is a dynamic and robust voice from the grassroots that is reflective of the diversity of communities affected by HIV/AIDS when crafting the National AIDS Strategy.
Randy Allgaier is the co-chair of the Grassroots Mobilization Workgroup of the Coalition for a National AIDS Strategy.