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We Want to Hear Your Comments about the National HIV/AIDS Strategy

Dr. Ron Valdiserri

Dr. Ron Valdiserri, HHS

The Federal Implementation Plan for the National HIV/AIDS Strategy (NHAS) requires the Deputy Assistant Secretary for Health to support the implementation of the Strategy by forging collaborations across HHS and with other Federal departments and by coordinating Federal efforts with States.

To help HHS do that job effectively, I want to ask the readers of this blog the following questions:

  1. What do you think are the most important parts of the NHAS and the Implementation Plan? What parts most impact the work you do?
  2. Can you suggest ways that the Federal government could do a better job of explaining how the Federal budget is used to support domestic (i.e., U.S. only) HIV/AIDS activities?
  3. What steps can HHS take to support and promote the integration of HIV prevention, care, and treatment services at the local level?

Please feel free to share any other thoughts you have about how we can work together to achieve the goals of the National HIV/AIDS Strategy.

You can leave us feedback by posting a comment on this blog.

Comments

  1. Robert Reinhard says:

    Thank you for the continued soliciting of ideas for the NHAS. By its nature, one element need not be more important than another since a coordinated whole strategy depends on all elements working effectively.
    I would like to comment in response to the third question’s application to care and treatment especially. Although there are high hopes and expectations resulting from healthcare reform, HIV affected populations are at great risk to be excluded from care or to experience disease enhancing discontinuities of care from aspects of the reforms as they exist today and even more so if those reforms are unfortunately repealed or challenged in coming years.
    Existing risks are due to, among other things:
    1) the requirement that access to high risk pools prior to 2014 depends on lacking insurance for 6 months before applying,and/or
    2) the grandfathering of some plans in existence prior to March 23, 2010 from some requirements
    3) severe shortfalls in ADAP and similar programs
    For those in need of treatment and care, the prospect of a secure, continuous and reliable program seems remote and fragmented, navigated, if at all, with tremendous difficulty. These problems will be even more serious if the architecture of reform is altered or dismantled.
    The government could take steps to mitigate this issue- but it should not take half or long delayed steps or others that increase complexity for use and uncertainty. Among ideas are:
    1) reform more – remove discontinuities of access to affordable comprehensive insurance- the $5 billion supplement to states is not a full measure and money must be supplemented with program reform
    2) increase ADAP support to states sufficient to meet needs- this is highly cost effective and yields cost savings to do so since continuous treatment support saves dollars in treating uncontrolled disease for those who are placed on waiting lists or excluded altogether
    3) extend COBRA eligibility beyond 18 months to 2014- eligibility to continue on a cobra plan not extension of the ARRA premium support. A COBRA premium paid by the participant is no cost to the employer and still much less than other alternatives to the insured individual.
    4) permit and support greater choice in selection of physicians and other healthcare staff beyond designated public centers since qualified specialty care is not evenly distributed in all locations.
    5) meet with pharmaceutical manufacturers to encourage reduced or lowered pricing for both public AND private drug dispensing. Offer incentives such as the FDA priority review voucher program (which would have to be expanded for this purpose), tax credits or other means of minimizing their overall revenue loss for these concessions.
    Finally, the NHAS and implementation says little or not much about support for
    biomedical research for improved prevention and treatment mostly now funded by NIH and some private companies. The President last year increased NIH funding for cancer research to meet a strategic objective and a similar increase for HIV research, sustained over the years coinciding with the aims of the NHAS, is supportable. It will also have the consequence to yield medical advances applicable to many other diseases. The President also announced the goal of increasing overall federal and private US spending on R&D to 3% of GDP to catch up with such spending internationally. HIV research should rise also coincident with those targets and not just to keep up with inflation.
    Thank you again.

  2. Marty says:

    HIV/AIDS is a perfect example of the human costs of policies out of sync with the needs of those most vulnerable. Policies that include abstinence only education in public schools, legal restrictions on access to sterile injection equipment and the so called “War on Drugs” have played a central role in the emergence of the HIV/AIDS epidemic, and only to the extent that these policies are reformed, will the U.S. see large reductions in HIV/AIDS at the population level

  3. Dianna Dean says:

    Good Morning,
    Our strategy here at Huston-Tillotson Health Services is to (Reach One Teach One Save One)one by one. Any person needing prevention education is a red flag to teach and test. More efforts towards vaccine reasearch is the only safe guard to stop or slow down HIV/AIDS.
    Nurse Dean

  4. Dave Barker, MD, MPH says:

    In general we agree with the President’s plan, which seems to balance attainable goals with desirable outcomes towards controlling the epidemic. Achieving Some of these goals will require federal systems to think in new ways – for example aligning disease intevention specialists (for partner referral) with HIV clinics and other service providers (methadone clinics) rather than local health departments. We also applaud the realistic appreciation that retention in care is crucial to the health of the patient and fully lowering community viral load. Where the Administration has so far failed is appreciating that per capita funding for HIV care has fallen each year for the past 9 years, and the benefits of health care reform will take years to begin to impact HIV care providers. We endorse the Admiministration’s efforts to help everyone who is infected become aware of their status, having seen six patients this Spring and Summer who presented with fatal opportunistic complications. It is beyond sad that these men and women will not gain the benefits that current HIV treatment can offer. It must also be recognized that the network of providers may not be able to continue to provide the quality care that each newly identified person deserves. Short of expanding PEPFAR funding to domestic programs, the Ryan White program remains the only viable way to support, in the near term, the care that needs to be provided. Congress and the administration either need to increase funding under Ryan White or find ways to reduce the cost of medications which constitute 50-67% of the overall cost of caring for HIV positive outpatients in the United States.
    Dave Barker, MD, MPH
    Chief Medical Officer
    The Ruth M. Rothstein CORE Center of Cook County
    Chicago IL
    The comments above represent the opinions of the author and may not be the official policy of the Cook County Health and Hospitals System or Cook County Government.

  5. Robert says:

    The plan as outlined is a welcomed change to the lack of a unified strategy over the past 30 years. By recognizing the many things that are done correctly by both government and non governmental agencies, we can build on successes and reach the goal outlined in the plan.
    However, funding must be distributed more equitably. Many areas of the country suffer from a lack of resources to address the issue and to decrease disease transmission before it reaches levels seen in large urban areas. All the funding cannot continue to go to Large urban areas and the south. We need increased funding in traditionally under funded communities across the country.

  6. Arena Beula says:

    1. What do you think are the most important parts of the NHAS and the Implementation Plan?
    Feedback is important. But the experience of survivors of cohorts, each medical team development strategies, make knowledge sharing. Always each doctor has his own strategy and experience.
    What parts most impact the work you do?
    The most important thing is to stop the number of deaths with AIDS. Implement shock therapy of vitamins combined with other natural therapies and nutritional therapies. Tranfered healthy antibodies , and inmonuglobulinas. Invite people to do prayer circle. See –>THE MEDICAL NEWS(Study finds proximal prayer may help another person’s healing 5. August 2010)
    2. Can you suggest ways that the Federal government could do a better job of explaining how the Federal budget is used to support domestic (i.e., U.S. only) HIV/AIDS activities?
    Prove it with infection rates and death rates. They have come down ?
    That awareness campaigns are doing in adolescents (secondary) and schools?
    3. What steps can HHS take to support and promote the integration of HIV prevention, care, and treatment services at the local level?
    Ensure the accessibility of the drug therapy actually independent of the status of the person??. Tell me about the most vulnerable people tell me that there has been progress in this society?!. But tell me specific numbers.
    In what sense have done more justice?.Implements a project call: And Justice adorn us

  7. Mardell Wheeler says:

    I am a women living with AIDS and I live in a community that still see’s AIDS a gay disease, all funding here has gone through the Health Department and they make it clear that they think anyone living with AIDS deserves it, I would like to see a change in the place where the funds are sent and provided to People living with AIDS and more monies for Education to help prevent the infection. Thank you for your time
    Mardell Wheeler

  8. Rajput says:

    Thanks for giving me a chance for comments. Regarding the federal budgets for HIV/AIDS. I think we should focus our energies on the following steps
    1.HAART containing foam or jellies and HIV vaccination,
    2.Reduce the HIV stigma and discremination,
    3. Increase the access of PLWHA to HAART.

  9. While some people squabbled and nitpicked over the effectiveness of the current NAS, at least 56,000 new infections were reported last year. As a PWA infected in 1983 and a SURVIVOR, I commend Obama for having the “audacity” to tackle such an equal opportunity disease and “hope” that the nation will support it. Well done Mr. Obama, and thank you for trying to keep me alive.

  10. Judith C. Levine, RN BSN says:

    I read the initiative. As usual the one thing that remains the same is that nurses are excluded from making the plan and its implementation. We are on the front lines of care provision, education, and teaching about prevention and but our knowledge and insights are nowhere to be seen.

  11. While it is indeed good to see the Obama White House begin to address the HIV/AIDS epidemic in a public policy statement.
    I further applaud testing and treatment as both of these steps will save lives in terms of primary and secondary infection. As well as getting people that couldn’t alone afford life saving treatment. The cost of a top of the line HIV treatment protocol can cost upwards of $24,000.00 annually; hardly what the average HIV infectted individual can easily afford.
    In terms of what can be improved or enhanced in the next version of a White House policy statement on HIV/AIDS is more effort at taking the stigma away from being HIV positive. Let me give an example how the current policy statement could be thought of as building on HIV’s stigma of who is infected, or who could be infected with HIV. There is no report of White or Latino heterosexual men under new incidents of HIV. Nor is there a projected rate of infection for these two populations. One could read this to mean HIV does not infect HIV heterosexual male whites or latinos. Or that male whites or latinos with HIV are IDU or MSM; but not heterosexual.
    Lastly, this is not a reflection of the Obama White House, but more a reflection of public health in general, or a reflection of past administrations. The HIV incident rate has largely been held flat since 1986 at 56,000 new cases a year. This is a 24 year period that we have not been able to halt or change the rates of HIV infection in spite of the fact that we are 100% certain of how HIV is spread.
    Interestly, mortality from HIV/AIDS is reported to have fallen to 13,000 people in the U.S. annually. This is a result of these highly effective drug cocktails, selling at full retail for $24,000 annually.
    Some how over the past 24 years we have not been able to halt or alter the continued spread of HIV in the United States of America. But we have been able to provide highly effective very expensive treatment to extend the lives of those living with HIV.
    I am glad to see the Obama White House rise to the HIV challenge. One is almost tempted to think this is unfair, and too easy, as there seems to be a lot of low hanging fruit surrounding improvement on the incident rate of HIV infections.

  12. Tim Ganley says:

    I think it’s important that whatever steps the government takes, they should not create more bureaucracy and red tape. I think the government should work with the pharmaceutical companies to bring down the cost of the drugs to the patient. At an annual cost of $24,000 or so, it makes it almost impossible for someone to get treatment who doesn’t have the best health insurance.