Panel at HealthHIV (photo by V. Maldonado)

Along with several Federal colleagues, I had the opportunity late last month to discuss the National HIV/AIDS Strategy (NHAS) and the Action Plan for the Prevention Care and Treatment of Viral Hepatitis (Action Plan) during a panel presentation at a national healthcare conference. We shared highlights of our efforts to coordinate activities as we implement both of these important plans with an audience interested in efforts to better synchronize networks of HIV and primary care, including representatives of a many community health centers at the conference organized by HealthHIV . Since many of the comments may be of interest to a wider audience, I wanted to share some of the highlights of those presentations.

In his opening statement, Dr. Kevin Fenton, Director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, noted that both the NHAS and the Action Plan call for closer coordination of efforts among Federal and local agencies and non-federal partners to build on successes and move toward the clear and specific goals set forth in each. Expanding prevention through healthcare, Dr. Fenton observed, is a major crosscutting priority. This includes making HIV and hepatitis screening routine.

I shared with the audience that implementation of the NHAS was continuing not only across the Department of Health and Human Services (HHS), but also in the five other Federal departments designated as leaders in the Strategy—the Departments of Housing and Urban Development, Justice, Labor, Veterans Affairs and the Social Security Administration. Meeting regularly, representatives of these agencies are seeking to improve coordination of HIV programs across departments and are seeking to identify one or more collaborative projects that will have a payoff at the service-delivery level. Within HHS, I shared that we are already engaged in conversations with the Secretary and the White House about reauthorization of the Ryan White Care Act. Finally, I shared that HHS is preparing a report highlighting important accomplishments in implementation of the NHAS over the past year. We anticipate this report will be released this summer.

Regarding the Viral Hepatitis Action Plan, I observed that an implementation group comprised of representatives from numerous HHS agencies and offices, including CDC, HRSA, IHS, NIH and SAMHSA, as well as the Department of Justice’s Bureau of Prisons and the Department of Veterans Affairs has been meeting regularly to advance implementation since the release of the Action Plan last May. We are also in the process of compiling a report of actions completed during the first year of the Action Plan and will also be sharing that this summer. Among the chief accomplishments of the first year has been significantly raising the profile of viral hepatitis as a significant health problem across all the participating agencies and laying the foundation for collaborative activities.

Dr. Deborah Parham Hopson, HRSA’s Associate Administrator for the HIV/AIDS Bureau, noted that three key challenges facing providers are identifying people with HIV earlier in the course of their infection, linking those people to HIV care, and keeping them in care. She spoke about how the Ryan White HIV/AIDS Program, which provides services to more than 500,000 people living with HIV (PLWH) across the U.S.—approximately one-half of the PLWH in the country—is working to address these challenges as well as supporting and expanding the HIV care workforce. On the latter, she highlighted HIV HRSA efforts to disseminate HIV information to providers in the National Health Service Corps, to integrate HIV training into residency programs, and to extend support to HIV providers in rural areas via a telehealth program. Dr. Parham Hopson also informed that participants that their input will be important as HRSA begins making plans for reauthorization of the Ryan White Program. She noted that HRSA will be gathering stakeholder input via a series of community meetings around the country as well as an opportunity to provide input online, which we blogged about last week. Finally, Deborah highlighted some of HRSA’s important work in implementing the Viral Hepatitis Action Plan, including efforts by the network of AIDS Education and Training Centers to scale up training on viral hepatitis diagnosis, care and treatment, noting that thousands of healthcare providers receive training annually through these centers.

Discussing efforts underway to expand and strengthen HIV care at the network of Community Health Centers (CHCs), Dr. Seiji Hayashi, Chief Medical Officer of HRSA’s Bureau of Primary Health Care (BPHC), shared that the 8,100 clinics supported through the health center program serve more than 20 million patients, approximately 90,000 of whom have a primary or secondary diagnosis of HIV according to 2010 data. More than 750,000 patients received HIV tests at CHCs in 2010. BPHC is working to increase the availability of HIV services by moving more health centers along the spectrum of HIV service delivery through various means, including program assistance letters, project officer training on HIV care, technical assistance for clinics, and other incentives.

Other important issues that were discussed during the panel presentation included violence against women, housing insecurity and homelessness, and behavioral health disorders. They were addressed by, respectively, Mr. David Vos, Director of the Housing Opportunities for People With AIDS program at the U.S. Department of Housing and Urban Development, Ms. Mary Bowers of the HHS Office on Women’s Health, and Mr. Warren Hewitt of the Substance Abuse and Mental Health Services Administration. Their comments helped place HIV/AIDS in a larger context as well as featured related Federal activities that the providers may find helpful for their patients.

Dr. Howard Koh

Tomorrow (May 19) our Nation marks the eighth annual National Asian and Pacific Islander HIV/AIDS Awareness Day and the first–ever National Hepatitis Testing Day. Both observances represent “calls to action” for the country and hold special meaning for me. As an Asian American physician, I have cared for many individuals living with HIV and/or hepatitis. As I stop to honor the patients I have served, I do so knowing these conditions continue to represent substantial health burdens for the AAPI community.

As a Nation, we need to continue our efforts to reduce new HIV infections to zero as we all work to achieve an AIDS-free generation. Some slight progress can be noted. In recent years, the rate of diagnosis of HIV infection among Native Hawaiians or other Pacific Islanders decreased while the rate of diagnosis among Asians has remained stable. In 2010, the rate among Native Hawaiians or other Pacific Islanders was 19.3 per 100,000 population (a decrease from 21.3 in 2007) and the rate among Asians was 6.5 per 100,000 population (the rate in 2006 was also 6.5) in the 46 states with confidential name-based HIV infection reporting. Those diagnosed accounted for approximately 2 percent of the 47,129 persons in the U.S. diagnosed with HIV during 2010. While these rates are relatively low compared to other racial/ethnic groups in the U.S., we need to redouble our commitment.

I remain inspired by the tremendous collaboration of  HHS and community partners to address HIV in AAPI communities and beyond:

• In the National HIV AIDS Strategy (NHAS) President Obama outlined three goals: 1) Reduce new HIV infections; 2) increase access to care and improve health outcomes for people living with HIV, and 3) reduce HIV-related health disparities. We must continue to work more closely with our federal and community partners, including representatives from diverse AAPI communities, to make the NHAS vision a reality.

• The Affordable Care Act is changing the landscape for health services delivery in the U.S. The Pre-existing Condition Insurance Program has increased access to preventive care, as well as initiatives to increase racial and ethnic diversity and cultural competency in the health care professions. HHS has also been implementing improved ways to collect and report health data related to race, ethnicity, sex, primary language, and disability status. Such progress will help us to better characterize and compare health problems in targeted populations and move us closer to our vision of a Nation free of health disparities.

• The Healthy People 2020 objectives are moving us to reduce disparities across diseases and across the life span in AAPI communities and beyond.

Federal funds are helping to address HIV in AAPI communities. Using Minority AIDS Initiative funding, The Office of Minority Health manages The Pacific Project , a capacity-building training and technical assistance project to increase HIV prevention and care services provided to the peoples of the U.S. Associated Pacific Island jurisdictions. Among the funded programs is The Asian Latino Pacific Healthcare Access Project , which is addressing stigma and lack of awareness of HIV/AIDS, promoting HIV prevention, early detection, and improved HIV management among Asian, Pacific Islander and Latino populations of Los Angeles who have limited English proficiency. The Centers for Disease Control and Prevention provides HIV prevention funding to community organizations and health departments. Some of the programs target subgroups within AAPI communities to enhance implementation of effective community-based HIV prevention programs. Among the grantees are Asian & Pacific Islander Wellness Center (San Francisco) and APICHA (New York City).

May 19 is also Hepatitis Testing Day

Today we also observe the first-ever national Hepatitis Testing Day. As I discussed in a post earlier this month, viral hepatitis, particularly hepatitis B, has a disproportionate impact on Asian and Pacific Islander communities. Asian Americans and Pacific Islanders make up less than 5 percent of the total population in the United States, but account for more than 50 percent of Americans living with chronic hepatitis B.  Fostering the observance of Hepatitis Testing Day is an important aspect of our cross-agency efforts to implement the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis (PDF 672KB), an effort I am honored to lead.

I encourage everyone to observe National Asian and Pacific Islander HIV/AIDS Awareness Day and Hepatitis Testing Day on May 19. You can:

• Learn more about the NHAS and the Affordable Care Act;
• Find an HIV testing site or other HIV services near you by entering your ZIP code into the HIV Prevention and Services Provider Locator;
• Use the National Asian and Pacific Islander HIV/AIDS Awareness Day resources provided by The Banyan Tree Project ;
• Visit CDC’s viral hepatitis page; and
• Use our new risk assessment tool to see if you should talk to your doctor about being tested for hepatitis.

Together we can make a difference in our response to these two epidemics within AAPI communities and beyond.

Dr. Ronald Valdiserri

As part of the Department of Health and Human Services’ (HHS) efforts to plan for the 2013 reauthorization of the Ryan White HIV/AIDS Program, the Health Resources and Services Administration (HRSA) has launched a number of activities to collect ideas from stakeholders that will inform our policy deliberations.

The Ryan White Program is the largest Federal program specifically dedicated to providing HIV care and treatment. It funds heavily impacted metropolitan areas, states, and local community-based organizations to provide life-saving medical care, medications, and support services to more than half a million people each year—including the uninsured and underinsured, racial and ethnic minorities, and people of all ages. Currently authorized by the Ryan White HIV/AIDS Treatment Extension Act of 2009, the program will be up for reauthorization by the U.S. Congress in 2013.

Among the issues being discussed within HHS is the question of what the Ryan White program should look like in an environment of a health care system reformed by implementation of the Affordable Care Act (ACA). In light of the expansion of health insurance coverage that implementation of the ACA will bring, the Ryan White Program will certainly evolve. But as my colleague Dr. Deborah Parham Hopson, HRSA’s Associate Administrator for the HIV/AIDS Bureau, has noted, though the reauthorized Ryan White Program may ultimately look different, it will still serve as an important “safety net” for vulnerable populations living with HIV/AIDS.

Stakeholder Comments Sought
In a Federal Register Notice dated April 25, 2012, Dr. Mary K. Wakefield, Administrator of HRSA, invited comments from stakeholders about reauthorization of the Ryan White Program. HRSA encourages stakeholders, including grantees, advocacy organizations, State and local administrators, and other members of the Ryan White and HIV/AIDS communities to provide comments on all aspects of the program. Submit written comments online by July 31.

Listening Sessions Planned
HRSA has also announced that it will hold at least four webinar or teleconference listening sessions over the next few months to collect stakeholder input on Ryan White Program reauthorization issues. Each will focus on a different geographic region. Dates, times and other details will be published on HRSA’s Ryan White Reauthorization web page as they become available.

The services offered through the Ryan White HIV/AIDS Program continue to be an essential component of our efforts to reach the goals of the National HIV/AIDS Strategy. We look forward to working with our colleagues at HRSA and stakeholders from across the nation to consider how the program can most effectively be adapted in light of evolving needs, priorities and policies.  I encourage you to share your thoughts on reauthorization via the forums that HRSA is making available.

Last week, the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA) issued a Funding Opportunity Announcement (FOA) that will support between 5 and 10 new Part C programs offering HIV early intervention services (EIS) in areas of the country where the HIV epidemic is increasing, demand for services has increased, and the availability of other HIV/AIDS services is limited. This funding opportunity stems from President Obama’s 2011 World AIDS Day initiative to expand primary HIV medical care and support services for people living with HIV/AIDS and it supports implementation of the National HIV/AIDS Strategy across the country.

Ryan White HIV/AIDS Part C programs provide HIV primary medical care in the outpatient setting. Applicants must propose to provide a comprehensive continuum of outpatient HIV primary care services in the targeted area including HIV counseling, testing, and referral; medical evaluation and clinical care; other primary care services; and referrals to other health services. In addition, Part C funded services should target the following 3 populations:

• Newly diagnosed/ identified persons with HIV infection,
• Previously diagnosed persons living with HIV/AIDS who have never been in care, and
• Persons living with HIV/AIDS who have dropped out of care.

Eligible applicants for this funding announcement include:

• Organizations in the U.S. and U.S. territories that are not currently funded by Part C EIS Public or nonprofit private entities, including Federally qualified health centers, rural health clinics, and family planning grantees
• Organizations including State and local governments, their agencies, and Indian Tribes or tribal organizations with or without Federal recognition; as well as community-based and faith-based organizations.

HRSA’s Associate Administrator for the HIV/AIDS Bureau, Dr. Deborah Parham Hopson, provides an overview of the funding announcement in this video:

Read more details on HRSA’s Funding Opportunities page and apply at Grants.gov by May 25, 2012.

Federal funding for HIV services is spread across multiple departments, agencies, and programs each with its own mission, priorities, and history. In order to achieve a more coordinated national response to the HIV epidemic, the National HIV/AIDS Strategy (NHAS) recommends that the Federal government develop improved mechanisms to: 1) monitor, evaluate, and report on progress toward achieving NHAS goals; and 2) simplify grant administration by standardizing data collection and reducing reporting requirements for HIV services grantees.

The U.S. Department of Health and Human Services’ (DHHS) agencies and offices that fund HIV prevention, care and treatment services use a number of independent information processing tools to collect programmatic, fiscal, and other data from grantees. These tools tend to use different performance indicators that vary in their specifications (e.g., numerators, denominators, time frames) and other ways. As a result, they are limited in their ability to work together or function as part of an integrated system, and this impedes the DHHS-wide monitoring of HIV service delivery and adds undue reporting burden to HIV services grantees.

Accordingly, DHHS has launched a new effort to explore the feasibility of establishing a centralized, secure, data reporting tool for grantees providing HIV services. It seeks to evaluate technological solutions to:

• Improve mechanisms to monitor, evaluate, and report on progress toward achieving NHAS goals
• Facilitate more coordinated program administration
• Reduce administrative and infrastructure costs associated with non-interoperable data systems
• Facilitate secure data sharing across Federal programs and between Federal and non-Federal partners

This undertaking is consistent with the White House Open Data Initiative and the HHS Open Data Plan, which urge efforts to streamline the collection, sharing, and processing of programmatic and fiscal data in a manner that increases transparency, participation, and collaboration.

Because we would like to hear your ideas about this project, we have published in the Federal Register a Request for Information (RFI) to invite comments on the design, deployment, operations, maintenance, and future enhancement of a centralized, secure, flexible data reporting system.

Responses to questions raised in the RFI are welcome and must be received no later than 5 p.m. EST on 5/17/2012. Electronic responses are preferred and may be sent to: HIVOpenData@hhs.gov.

J. Nadine Gracia

As we commemorate National Minority Health Month during April, we recognize that this is truly a moment of unprecedented opportunity for health equity – including equity in HIV prevention and care.

One year after the launch of the Department of Health and Human Services (HHS)’ first-ever Action Plan to Reduce Racial and Ethnic Health Disparities and the National Partnership for Action’s National Stakeholder Strategy for Achieving Health Equity, the Federal government is embracing a renewed commitment to health equity.

One area of importance is reducing disparities in HIV infection and care for racial and ethnic minorities, who accounted for almost 71 percent of newly diagnosed cases of HIV infection in 2010 among adults and adolescents in the 46 states with mature HIV reporting, according to CDC’s latest data.  While blacks represent 12 percent of the population of the 46 states, for instance, they accounted for 46 percent of new HIV diagnoses in 2010. Latinos, who represent about 16 percent of the population, accounted for 20 percent of new HIV diagnoses that year. In addition, while they represent much smaller shares of newly diagnosed HIV infections, American Indians/Alaska Natives, Native Hawaiians, and Other Pacific Islanders were diagnosed with HIV at higher rates than their white counterparts in 2010, according to the CDC’s 2010 HIV Surveillance Report.  (HIV/AIDS rates among Asian Americans are lower than those found in any other racial and ethnic group.)

The fight against these disparities has drawn momentum since the release of the National HIV/AIDS Strategy (NHAS). Released by the President in July 2010, the NHAS declares that “a national response to the HIV epidemic needs to be mindful of the size, diversity, and richness of our country, as well as the needs of the most affected communities.  The NHAS not only represents the nation’s first-ever comprehensive HIV strategy; it is also the first time that HIV-related disparities have been acknowledged at such a high level, and targeted with strategies focused on support for underserved communities. The Office of Minority Health is proud to be among the agencies and offices across HHS working together to provide a more coordinated response to HIV/AIDS in the United States.

Meanwhile, the Affordable Care Act is helping to ensure better care for people living with HIV/AIDS.  With greater options for stable, affordable health insurance coverage; protection from insurance company abuses; and increased opportunities for health and well-being, people living with HIV/AIDS will benefit from a health care system that puts consumers first.

Most recently, HHS announced the availability of $15 million in funding for community-based organizations across the country that provide care and critical services to people living with HIV and AIDS through both supplemental and new funding in the Ryan White program. By improving and increasing access to care for people living with HIV, this initiative will help to reduce HIV-related health disparities – a critical objective in the implementation of the NHAS.

And at the Office of Minority Health, we are developing policies and programs to address the burden of HIV/AIDS on communities of color.  For instance, our HIV/AIDS Health Improvement for Re-Entering Ex-Offenders (HIRE) Initiative seeks to bridge HIV-related health care gaps by linking HIV-positive ex-offenders who are re-entering the mainstream population to comprehensive health care and case management services.

But even as these initiatives spur progress, one thing is clear: realizing our vision of an AIDS-free generation will depend on far more than leadership by government agencies.  In the fight against the national HIV epidemic, everyone is a stakeholder.  And everyone can take action.

This year, we have designated the theme for Minority Health Month to be “Health Equity Can’t Wait: Act Now in Your CommUNITY!” – a call to action for stakeholders everywhere to join in raising awareness about health disparities and health equity.  To find out more, and join in the movement, visit http://minorityhealth.hhs.gov/actnow/.

Universities and colleges play an important role in the nation’s response to HIV/AIDS—educating young people; preparing the next generations of health care providers, researchers, teachers, and public health professionals; conducting research that helps us improve our response; and even educating their faculty, staff and communities about HIV/AIDS. In fact, the National HIV/AIDS Strategy points specifically to education institutions as vital partners in reaching the Strategy’s goals. A number of Historically Black Colleges and Universities (HBCUs) are engaged in significant efforts to educate students and promote HIV awareness across their campuses. These efforts are particularly important given that African Americans face a very severe and disproportionate burden of HIV disease in the United States. Despite representing only 14% of the US population in 2009, African Americans accounted for 44% of all new HIV infections in that year, according to the CDC. Alarmingly, CDC also reports that more new HIV infections occurred among 13–29 year-old black gay and bisexual men who have sex with men (MSM) than any other age and racial group of MSM; further, new HIV infections among young black MSM are trending up, increasing by 48% from 2006–2009. Of the total number of new HIV infections in U.S. women in 2009, 57% occurred in blacks, and the rate of new HIV infections among black women in 2009 was 15 times that of white women. These realities make the HIV prevention efforts of the nation’s HBCUs all the more important.

Morehouse College Takes on HIV and Hosts White House Conference
Earlier this year, Morehouse College, an all-male historically black institution in Atlanta, Georgia, commemorated National Black HIV/AIDS Awareness Day (NBHAAD) with a number of activities held on campus on February 7, 2012. These included HIV testing for students, participation in the Greater Than AIDS “Deciding Moments ” photo initiative, and a candlelight vigil. The day also featured a panel of students, Morehouse alumni, representatives of local AIDS service organizations, and community members who engaged in a lively discussion regarding masculinity, sexuality, homophobia, and HIV risk. Students from two nearby HBCUs, Clark-Atlanta University and Spellman College, also participated in the discussion demonstrating their support and solidarity in HIV prevention.

HIV awareness efforts are not, however, only a once a year activity at Morehouse. Among the organizers of the campus-wide NBHAAD activities was Health Educators of Morehouse (HEM), which engages fellow students on HIV/AIDS awareness year round through the facilitation of panels and the delivery of condoms to students on campus. HEM has also successfully advocated for increased availability of HIV and STI testing on campus. Also, last Thursday, April 18, 2012, Morehouse was the site of the White House LGBT Conference on HIV/AIDS .  Hosted by the White House Office of Public Engagement and the White House Office of National AIDS Policy in partnership with Morehouse School of Medicine, the one-day conference provided advocates, community leaders, and members of the public an opportunity to engage in conversation with representatives of the Obama Administration on issues related to the impact of the HIV/AIDS epidemic on the lesbian, gay, bisexual and transgender community (LGBT) and associated HIV/AIDS-related health disparities.

Strengthening HIV Prevention at Other HBCUs
Four other HBCUs have been participating in a multi-year effort to assess and strengthen their campus-wide HIV prevention activities as participants in the Minority-Serving Institutions’ (MSI) HIV/AIDS Prevention Sustainability Demonstration. Initiated by the Office of HIV/AIDS and Infectious Disease Policy (OHAIDP) with funds from the Secretary’s Minority AIDS Initiative Fund, the demonstration project is working to advance new strategies to increase HIV prevention activities for minority youth (ages 18-25). Through the initiative, the four HBCUs—Jackson State University, Southern University at Baton Rouge, Fort Valley State University, North Carolina Central University—along with two Tribal Colleges and a Hispanic Serving Institution receive technical assistance designed to increase their capacity to address HIV prevention and sexual health needs of minority college and university students and foster new partnerships to promote these health activities. Each of the MSIs has developed and is now working to implement a program focused on increasing awareness and knowledge of risk factors and prevention methods for HIV/AIDS transmission; reducing high-risk behaviors; and increasing access to counseling, testing, and referral services.

Among the many activities underway at the HBCUs, Southern University has created a “HIV 101” module for an introductory health course mandated for all incoming freshman students. At Ft. Valley, they are adapting two of the DEBIs —evidence-based behavioral interventions that have showed positive behavioral (e.g., use of condoms; reduction in number of partners) and/or health outcomes—Nia  for male students and SISTA  workshops for female students. Jackson State is also tailoring another DEBI, Popular Opinion Leaders , for the young men on campus while also recruiting and training new peer health educators.  North Carolina Central is engaged in a social marketing campaign that delivers HIV prevention information to students via multiple channels including a webpage, Twitter, and print materials as well as adapting SISTA for its female students.

These are just some examples of how HBCUs are responding to HIV/AIDS. What’s happening in your community to educate young people about HIV/AIDS? If you are at an HBCU, how is it addressing HIV? If you are in the community, how are you encouraging and assisting local colleges and universities in their efforts to educate students? Share your thoughts in the Comments section below.

AIDS.gov team member Naima Cozier contributed to this blog post.

AIDS.gov recently spoke with Dr. Michael Horberg, Director of HIV/AIDS for Kaiser Permanente and a member of the Presidential Advisory Council on HIV/AIDS (PACHA), about the Kaiser Permanente HIV Challenge , an important private sector effort to improve the delivery of HIV care in support of the goals the National HIV/AIDS Strategy. Announced earlier this year at the CMS Health Care Innovations Summit, the Challenge aims to help health care providers nationwide improve health equity for people living with HIV by increasing access to HIV care and improving health outcomes. Kaiser Permanente challenges other private health care providers and community health clinics to increase the number of HIV-infected people getting treatment by sharing Kaiser Permanente’s toolkit of clinical best practices, tools, mentoring, training and health IT expertise.

Watch our conversation below.

Gregorio Millett

Yesterday, the Institute of Medicine (IOM) released a long-awaited report commissioned by the Office of National AIDS Policy back in 2010. IOM was tasked with recommending a list of essential indicators that can be standardized across various databases to provide a snapshot of the use of clinical services among people living with HIV/AIDS (PLWHAs).  Recent scientific advances have placed a premium on the importance of clinical care for PLWHAs. The implementation of the Affordable Care Act (ACA) and the development of the National HIV/AIDS Strategy create a unique opportunity to dramatically improve the health outcomes of PLWHAs in the United States as well as opportunities to monitor and improve care provision.

A parallel effort of identifying a core set of common indicators to monitor Federally-funded HIV prevention, treatment, and care services is also underway at the U.S. Department of Health and Human Services. (Review this recent presentation [PDF 344KB] to PACHA about the HHS efforts to implement common core indicators, streamline data collection, and reduce reporting burden for HHS-funded HIV programs.)

Working in collaboration, HHS’s efforts and the new Institute of Medicine report move us further toward achieving the streamlining and standardization across data collection measures stipulated in the National HIV/AIDS Strategy and fulfilling the Strategy’s vision to provide “unfettered access to high quality, life-extending care, free from stigma and discrimination.”

More information on the IOM report, including a brief and the full report, can be found on their website .

Nancy Mahon

At the end of last month, the Presidential Advisory Council on HIV/AIDS (PACHA) convened for its first meeting of 2012. It was my privilege to lead that meeting, my first as PACHA’s new chairperson. Our agenda was a very full one and the discussions thoughtful, rich, and informative. As we embarked on our work, we were all mindful of and inspired by the President’s historic commitment to end the HIV/AIDS epidemic, which he made on World AIDS Day 2011—just several weeks before we met. This Administration’s commitment to that goal informed and fueled all of our discussions during our two-day meeting. Here are a few highlights:

We were especially pleased to hear from three key leaders from the Administration:

• Dr. Howard Koh, Assistant Secretary for Health, reflected on the many significant advances of the past year, including new HIV research findings, budget realignment, implementation of more provisions of the Affordable Care Act, and launch of the Viral Hepatitis Action Plan which serves as an important complement to HIV/AIDS prevention, care and treatment efforts. He urged the Council to be thoughtful in our efforts to identify ways to leverage these advances.

• Health and Human Services Secretary Kathleen Sebelius thanked the members of PACHA for their thoughtful ideas and active engagement, noting that the impact of their efforts is evident in many of the advances of the past year. She shared that progress on the National HIV/AIDS Strategy (NHAS) was among the issues the President regularly asks her about and that, moreover, she was pleased to be able to report on progress by both Federal agencies and non-Federal sectors working to achieve the Strategy’s goals. To continue building on this momentum, she made the important observation that the upcoming International AIDS Conference will be an opportunity to “turn up the volume” on the national conversation about HIV/AIDS, reminding Americans of its continued impact here in the U.S., and the need to sustain and strengthen efforts to bring the epidemic to an end. Finally, the Secretary reiterated the important role PACHA will play in ending the epidemic in the U.S. through their advice about programs and policies that will ensure more people living with HIV are diagnosed, linked to and maintained in high quality HIV care and treatment.

• Cecilia Muñoz, the President’s Domestic Policy Advisor and the Director of the Domestic Policy Council, also addressed the PACHA. “Its important to reflect on how far we’ve come, but this fight isn’t over for families, communities, or this President,” Ms. Muñoz observed. She shared that as the mother of daughters she was especially pleased that the PACHA was focusing on issues of women and HIV/AIDS at this meeting. The White House, she announced, would be continuing this examination in March with a symposium complementing the observance of National Women and Girls HIV/AIDS Awareness Day.

Examining Women and HIV

The PACHA spent most of the first day of our two-day meeting listening to experts on dimensions of women and HIV. Researchers, providers, and advocates shared perspectives on unique risks for HIV among women as well as distinct care and treatment issues. The presenters and the members of PACHA who organized the session all sought to ensure that the nation’s HIV systems, services and policies work for everyone, including women. Several speakers underscored the principle that ensuring that the unique needs of women are addressed need not become a question of “either women, or some other population,” but a case of “both women, and other populations.” Among the themes that emerged during the daylong discussion were the importance of:

• Focusing on the social determinants of HIV vulnerability for women;
• Studying further the intersection of childhood and adult sexual violence as a risk factor for HIV infection in both women and men;
• Understanding the impact of geographic hot spots of HIV on the likelihood of HIV infection among women;
• Incorporating HIV prevention and care into reproductive health care for women;
• Supporting efforts to sustain and continue the reductions in mother-to-child transmission;
• Strengthening efforts to study and improve care for women with HIV as they age; and
• Identifying effective models for connecting and retaining women in care, which may include family-centered or gender-specific approaches.

Other Topics Discussed

• HOPWA Modernization—Mr. David Voss of the U.S. Department of Housing and Urban Development discussed plans for modernizing the Housing Opportunities for People with AIDS (HOPWA) program. Noting that the current formula for distributing HOPWA funds does not reflect the current nature of the epidemic, Mr. Vos explained that HUD is working on an updated formula based on the number of people living with HIV and adjusted for an area’s fair market rent and poverty rates. This will result in better focusing HOPWA resources on the areas with the most need.
• Expansion of Behavioral Health Services Under the Affordable Care Act—The PACHA also heard from SAMHSA representatives about activities underway to ready states and the behavioral health field for the approximately 11 million currently uninsured individuals with mental health and substance abuse conditions who will become eligible for care in 2014 under the Affordable Care Act (ACA), either under Medicaid expansion or through the insurance exchanges. This expansion of behavioral health services will have significant potential for improving treatment for persons living with HIV who also have mental illness or substance abuse issues. Members of PACHA were interested in seeing a similar analysis of the number and characteristics of people living with HIV/AIDS whose eligibility for healthcare will change with implementation of the ACA.

After hearing these and other presentations the members of the PACHA and I were left with much to consider. I urged the Council to be thoughtful and specific in our work, pressing them to be the PACHA that fully embraces the vision of the National HIV/AIDS Strategy to bring AIDS to an end in America.  I acknowledged that there may not always be enough information or resources; but, it is up to the Council—and all working in the HIV/AIDS field—to make the best possible use of everything that is now available, targeting it for the best possible impact for people at risk for and living with HIV.