Dr. Ronald Valdiserri

With an estimated 20 percent of people living with HIV in the United States unaware of their status, strengthening our HIV testing efforts will be key to achieving the goals of the National HIV/AIDS Strategy (NHAS). Fortunately, many innovative HIV testing efforts are underway in communities across the country.

HIV testing is integral to HIV prevention, treatment, and care. Knowledge of one’s HIV status is important for preventing the spread of disease. Studies show that individuals who learn they are infected with HIV take active steps to reduce the likelihood of transmitting the virus to their partners. Early diagnosis of HIV helps to ensure that people living with the virus are linked into care and receive life-saving treatment. And recently we’ve learned that antiretroviral treatment can also help to prevent the further spread of HIV. Therefore, the NHAS aims to increase, by 2015, from 79 percent to 90 percent the percentage of people living with HIV who know their serostatus (from 948,000 to 1,080,000 people).

From Maine to California, health departments, community-based organizations, substance abuse and mental health programs, health care providers, hospitals, and others are implementing novel and effective approaches to HIV testing to help contribute to this important outcome. Examples we’ve heard about recently include:

• HIV Screening Offered at the Department of Motor Vehicles – An innovative example of the Strategy’s call for greater collaboration among government service providers is underway in Washington, DC, where HIV testing has been offered at the Department of Motor Vehicles for the past year. While waiting to get a driver’s license, temporary tags or other services, motorists visiting the Department of Motor Vehicles service center in the nation’s capital can get a free HIV test. This innovative collaboration between the DMV and the DC Department of Health (DOH) has tested more than 5,000 people since the program started in a single location in October 2010. According to Family and Medical Counseling Service Inc., the non-profit group that runs the program under a grant from DOH, between 25 and 35 people get tested every day, and anyone who is tested gets $7 off his or her DMV services. If someone tests positive, the nonprofit offers a ride to its office where staff can set up counseling and a doctor’s appointment. Building on the success of the DMV effort, officials expanded the program in late 2011 to offer testing at an office where Washington residents register for food stamps, Medicaid, and other government assistance. The same nonprofit will run the program there, offering as an incentive a $5 gift card to a local grocery store.

• Testing at Community Activities – In Pine Ridge, South Dakota, the Oglala Sioux  tribe partnered with its local Indian Health Service facility to increase the availability of HIV screening in nonclinical, community-based settings. An experienced and well-regarded public health nurse has taken HIV testing to events and venues where there may not normally be a health-related activity. Over the past year, this locally initiated program has offered confidential HIV testing at community potlucks, rodeos, basketball games and Pow Wows.  Bringing HIV testing to nonclinical settings has allowed them to reach community members who may not be in regular health care, including young people, and provide them with HIV education and the opportunity for confidential HIV testing.

• Promoting the HIV-STD Link and Encouraging Screening – Responding to a recent special surveillance report indicating a 23% increase in the number of primary and secondary syphilis cases in Chicago and a documented high rate of HIV-syphilis co-infection especially among MSM, the Chicago Department of Public Health  recently launched the “Get Tested Chicago ” campaign to encourage individuals to get tested for HIV and other Sexually Transmitted Infections (STI), including syphilis and, if diagnosed, to get into care. The public awareness campaign includes targeted billboards, radio public service announcements (PSAs), and bus advertisements aimed at early detection, testing and awareness.  The campaign makes the link between syphilis, as well as other sexually transmitted infections, and HIV. It notes that studies have repeatedly demonstrated that people are more likely to become infected with HIV when other STDs are present.  Moreover, it informs Chicagoans that if a person is HIV-positive, or if the immune system is weakened for any reason, syphilis (and other STIs) may progress faster and do more damage to the body.

• Would you or wouldn’t you take an HIV test?” – In San Diego, the “Lead the Way ” campaign reflects the Strategy’s call to intensify HIV prevention efforts in communities where HIV is most heavily concentrated. The campaign aims to have all adults in the city’s 92103 and 92104 ZIP codes answer the question, “Would you or wouldn’t you take an HIV test?”  Researchers at the University of California, San Diego (UCSD), designed and are implementing “Lead the Way,” with support from the National Institutes of Health. “UCSD researchers want to show that we can reduce the spread of HIV now, even without a vaccine. HIV testing is easy, confidential and is the simplest way to help our local community fight the spread of HIV/AIDS,” observed Susan Little, MD, professor of medicine in UCSD’s Division of Infectious Diseases and lead researcher of  “Lead the Way.” The campaign operates a drop-in testing center and sets up mobile testing sites at a variety of community events and venues. In addition, trained HIV testers from UCSD’s Antiviral Research Center are visiting residential locations in randomly selected areas throughout the two ZIP codes to offer free rapid HIV tests that will provide results in minutes. Those that do not wish to participate in the finger-prick test will have the option of completing a brief survey. “Volunteering to take the quick finger-prick test or filling out the survey will help us understand why people will or will not take an HIV test.  If we can understand the psychology, we can create more effective campaigns to promote testing. The ultimate goal is that everyone gets tested and those who need treatment receive it, so we can significantly curb the spread of HIV,” Dr. Little said.

These are just some of the many significant steps taken over past year to help the nation reach the Strategy’s goals. What innovative approaches to HIV testing are underway in your community? Share your examples to inspire others in the Comments section below.

For more information, visit CDC’s HIV Testing page or read the Kaiser Family Foundation’s 2011 fact sheet “HIV Testing in the United States”.

Last week, the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA) issued a Funding Opportunity Announcement (FOA) for the Ryan White HIV/AIDS Program Part D Grants for Coordinated HIV Services and Access to Research for Women, Infants, Children, and Youth (WICY). According to HRSA the entire $70 million Part D program is being re-competed through this FOA in order to respond to changing HIV epidemiology and better address the goals of the National HIV/AIDS Strategy (NHAS) by providing comprehensive health care services for the WICY populations in areas of greatest need for services.

There have been changes in HIV epidemiologic trends in the United States over the past two decades.  Effective antiretroviral (ARV) drugs for therapy and prophylaxis have been discovered and are widely available. Transmission of HIV from mother to infant has decreased tremendously with universal prenatal HIV testing and ARV prophylaxis. Today, children comprise only 1 percent of the HIV epidemic in the United States. Women, especially women of color, now comprise 28 percent of all people living with HIV in the United States. And among persons aged 13-29 years, it is estimated that HIV incidence has increased 21% in recent years—driven largely by increased incidence in young men who have sex with men (MSM), especially young black MSM.  Ryan White-funded services should ensure that newly identified PLWH, especially young African American MSM are linked into healthcare, provided ARV medications, and retained in care.

The FOA solicits grant applications from organizations throughout the U.S. and its territories to provide family-centered primary medical care to women, infants, children, and youth living with HIV/AIDS when payments for such services are unavailable from other sources.  Funding is intended to improve access to primary HIV medical care for HIV-infected women, infants, children, and youth through the provision of coordinated, comprehensive, culturally and linguistically competent services.

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

Part D grantees are expected to provide HIV primary care, specialty medical care, and support services to the clients they serve. The FOA requires that, to the extent possible, program activities should strive to support the three primary goals of the NHAS. As encouraged by the NHAS, programs should seek opportunities to increase collaboration, efficiency, and innovation in the development of program activities to ensure success of the NHAS.

Grant applications are due March 16, 2012. HRSA estimates that approximately 200 awards will be made. Grant applicant technical assistance webinars are being provided. Visit the Target Center for more information.

Visit HRSA’s web site for more information about the Funding Opportunity Announcement and the Part D Program.

Dr. Howard Koh

As 2011 draws to a close and we look ahead with anticipation to the New Year, I want to honor the members of the HIV/AIDS community for their passion in advancing toward our goal of achieving an AIDS-free generation.

Through our collective commitment to implement the National HIV/AIDS Strategy (NHAS) and the Action Plan for Viral Hepatitis, our nation saw progress this year to match this passion. We have moved closer to the Strategy’s goals of reducing new HIV infections, improving access to HIV care, improving health outcomes for people living with HIV, and reducing HIV-related health disparities. Furthermore, by tackling the silent epidemic of hepatitis, we are helping so many co-infected while addressing another major public health challenge.

The Office of the Assistant Secretary for Health (OASH) was tasked by the NHAS to improve coordination of HIV/AIDS across the Department of Health and Human Services, and with other Federal agencies and departments. As a result of this new role, my office had the opportunity to work alongside a talented and committed cadre of Federal colleagues who stepped forward to support the Strategy’s goals and outcomes. Together, we have strengthened and coordinated HIV/AIDS activities across agencies and departments; better aligned resources to address the epidemic; promoted the “12 Cities” project as a way to enhance integration of Federal HIV/AIDS programs; moved toward common reporting metrics; and, clarified a path toward achieving better outcomes.  In addition, our engagement during the past year with a broad array of non-Federal partners, including those from state and local governments, academia, the faith community, the business and philanthropic sectors, and the media, has unified and revitalized the national commitment to HIV/AIDS.

This year also marked the 30th year since the first reported cases of AIDS, a milestone that makes us reflect on our remarkable journey since those dark days when HIV infection was poorly understood and almost always fatal.  Remarkably, three decades of scientific progress in HIV/AIDS prevention and treatment, coupled with the development of new policies, programs, and partnerships, has brought us to a pivotal moment where we can envision an AIDS-free generation.

In the coming year, we will continue to strengthen these efforts along with our Federal and non-Federal partners, by taking advantage of recent scientific discoveries, and implementing policies and programs that support HIV prevention, testing, and treatment efforts. The XIX International AIDS Conference set for July 2012 in Washington, DC, will be an exciting opportunity for us to join in a global effort to assess our progress on HIV/AIDS, evaluate recent scientific developments, and collectively chart a course forward toward an AIDS-free generation.

As I look to the challenges ahead, what motivates me most is the courage of the first patients with HIV/AIDS for whom I cared during my medical training in Boston all those years ago. Those patients, as well as those currently living with HIV/AIDS and advocates worldwide, continue to inspire our critical efforts to combat this devastating epidemic. By working together in the coming year, we can honor the legacy of those who have gone before us and make the HIV/AIDS Strategy’s life-saving goals a reality in the years to come.

This month, Mr. Jeffrey Crowley ends his tenure as President Obama’s Director of the Office of National AIDS Policy(ONAP) and Senior Advisor on Disability Policy, positions he has held since 2009. We acknowledge, with sincere gratitude, Jeff’s significant contributions to fulfilling the President’s commitment to develop the United States’ first comprehensive National HIV/AIDS Strategy. Since the Strategy’s release in July 2010, I have had the pleasure of working closely with Jeff and his colleagues in ONAP to implement the Strategy across the Department of Health and Human Services (HHS) and other lead Federal Departments.

Jeff often observes that he has accomplished nothing alone, pointing to the unprecedented levels of stakeholder input into the development of the Strategy and the tremendous commitment of time, energy, innovation, and dedication that we’ve witnessed at all levels of government, in the community, and from the private sector since the NHAS was released.  But it is important to acknowledge that these outcomes were strengthened by Jeff’s thoughtful and steady leadership.

We wish Jeff all the best—including a well-deserved vacation—and know that he will remain a strong advocate for all of us who want to make the vision of the NHAS a reality in our Nation:

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

Jeff recently shared his thoughts with AIDS.gov in this video interview, reflecting on the NHAS and looking ahead to opportunities for the HIV/AIDS community to continue advancing the Strategy’s goals.

Dr. Ronald Valdiserri

At a recent (12/5/11) summit of the philanthropic community, in Washington, DC, Funders Concerned About AIDS (FCAA) launched the Funder’s Toolkit for the National HIV/AIDS Strategy . Throughout the development and implementation of the National HIV/AIDS Strategy (NHAS), a strong emphasis has been placed on the need for the engagement and participation of all sectors of society in order to achieve the Strategy’s goals; the President himself has acknowledged that the Federal government cannot do this essential work alone.  At this “all-hands-on-deck” moment, we must work in new ways, across disciplines and organizations, to make lasting progress on the American HIV/AIDS epidemic—especially in terms of reducing HIV-related health disparities.  The summit and the new online toolkit are important steps in advancing the contributions of the nation’s vital philanthropic sector to achieving the vision of the NHAS.

During FCAA’s AIDS Philanthropy Summit, leaders from the philanthropic community and other interested stakeholders discussed how the NHAS offers an unprecedented opportunity for philanthropy – focused on AIDS and beyond – to partner with government, business, research, policy makers, faith communities, advocates and people living with HIV/AIDS in order to eventually bring about the end AIDS in America. I had the opportunity to participate in the summit, joining a panel of colleagues who discussed the implementation of the NHAS from state, local and federal perspectives.

FCAA developed the new online toolkit in response to stakeholders who’ve been asking how they might partner with and support the National HIV/AIDS Strategy. The toolkit identifies opportunities for funders to help the NHAS reach its goals, and highlights the work of funders already supporting this historic and important strategy.  To help inform and engage funders who may not yet be working in this arena, the toolkit also offers a “NHAS 101” section. It then provides eight specific recommendations on how philanthropy can align with the NHAS and highlights several current examples of work by funders in each area.

According to FCAA, the goals of the Toolkit include:

• Providing private philanthropy with the context for making investment decisions related to the NHAS;
• Identifying opportunities for investments by private philanthropy that will help this historic and important plan reach its goals;
• Fostering greater collaboration among funders and more integrated efforts between private philanthropy and government;
• Highlighting the work of funders and their grantees around the country;
• Indicating opportunities for philanthropy to exercise its unique role in responding to populations and issues that governments cannot always address because of ideological, cultural and political barriers; and
• Engaging funders beyond the immediate community of AIDS funders in supporting the NHAS.

Founded in 1987, FCAA is the only U.S.-based organization comprised of and for private philanthropic institutions concernedabout, engaged in or potentially active in the fight against HIV/AIDS.  FCAA mobilizes the leadership, ideas and resources of U.S.-based funders to eradicate the HIV/AIDS pandemic.

Please take a look at the NHAS toolkit; I know you will find it impressive. And I encourage you to share this important resource with friends and colleagues so that we can extend the vision of the NHAS throughout the United States:  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.

Congresswoman Barbara Lee (D-CA); Phill Wilson, CEO of the Black AIDS Institute; Jeffrey Crowley, Director, White House Office of National AIDS Policy; Frances Ashe-Goins, HHS Office on Women’s Health; and Greg Millett, CDC, address the NAACP summit.

To raise greater awareness of the disproportionate impact of HIV/AIDS in the African American community and mobilize action by community members, the National Association for the Advancement of Colored People (NAACP) and the Harvard University Center for AIDS Research co-hosted a summit in Washington, DC last month. The November 2 gathering, “The Forgotten Epidemic: Our Collective Response, Responsibility & Solution to the Black AIDS Crisis,” also highlighted how the National HIV/AIDS Strategy and the Patient Protection and Affordable Care Act are helping to address HIV/AIDS in the African American community.

According to the Centers for Disease Control and Prevention (CDC), African Americans face the most severe burden of HIV of all racial/ethnic groups in the United States. Despite representing only 14% of the U.S. population in 2009, CDC estimates that African Americans accounted for 44% of all new HIV infections in that year. Compared with members of other races and ethnicities, African Americans account for a higher proportion of HIV infections at all stages of disease—from new infections to deaths. African American gay and bisexual men and African American women continue to be among the hardest hit populations. (Read the CDC’s new fact sheet HIV Among African Americans.)

NAACP’s CEO, Benjamin Todd Jealous, and Chairman, Roslyn Brock, address the summit.

Audience members and panel participants spoke passionately about the role that social determinants of health play in sustaining those HIV-related health disparities.  They also discussed their shared commitment to mobilizing to end the epidemic. “This is an issue for many of us; 41 percent of Black people in this country know somebody who has the virus. For many of us this is very close to our hearts,” said NAACP President and CEO Mr. Benjamin Jealous. “The association is no different. We’re committed to being a powerful voice … We’re committed to pushing the conversation even further at the church level and the community level.”

Addressing these stark HIV-related disparities during the summit were speakers from across the Federal government including Mr. Jeffrey Crowley, Director of the White House Office of National AIDS Policy, who discussed how the National HIV/AIDS Strategy calls for prioritizing efforts targeting heavily impacted communities, including African Americans, as well as the importance of increasing HIV awareness and testing and reducing stigma among the same populations. The approximately 80 participants also heard from CDC’s Dr. Jonathan Mermin, RADM Deborah Parham-Hopson of the HIV/AIDS Bureau at the Health Resources and Services Administration, Mr. Greg Millet of CDC, and Mr. Christopher Bates, Executive Director of the President’s Advisory Council on HIV/AIDS (PACHA). Mr. Millett spoke to the importance of addressing HIV stigma and homophobia in the African American community as part of efforts to reduce new HIV infections and improve access to HIV care and health outcomes in the same community. Finally, Mr. Bates spoke about PACHA’s commitment to focusing attention on the populations and communities that have been hardest hit by the epidemic, including African American gay and bisexual men and African American women.

Offering a perspective from Congress were Representatives Barbara Lee of California and Eleanor Holmes Norton of Washington, DC. Congresswoman Lee, co-chair of the Congressional HIV/AIDS Caucus, spoke about her work to end HIV-related discrimination and stigma, which hinders the nation’s efforts to prevent new infections and retain those living with HIV in care and treatment.

“The NAACP has identified HIV/AIDS as a national priority,” said Ms. Shavon Arline, NAACP’s Director of Health Programs. “We realize this is the number one killer among African American women ages 25-44 and will continue to raise awareness and bring a sense of urgency to this epidemic to save our families.” The summit was just one of several HIV/AIDS awareness and advocacy activities underway at NAACP, which is a partner in CDC’s Act Against AIDS Leadership Initiative.

Underscoring the organization’s commitment to addressing HIV/AIDS, Ms. Rosalyn Brock, the national chairperson of the NAACP, closed the meeting with a rousing call to action. Invoking the perseverance and dedication of America’s civil rights leaders she urged the participants to be persistent in their efforts to educate and inform friends, family, colleagues and leaders at the local, state and national levels about the continuing impact of HIV/AIDS in the U.S. and what needs to be done to address it, particularly among communities of color.

Today, December 1, we commemorate World AIDS Day. This has been a year of reflection as we marked the 30th anniversary of the first reported cases of AIDS on June 5, 1981. AIDS is still here, and it affects all of us in the U.S. and around the world. AIDS has been, and continues to be, an important issue for the disability community, which has worked diligently to end stigma and discrimination against people living with HIV/AIDS and ensure that they have access to job skills training, employment services, housing and other supportive services.

This year has also been a year of hope; the result of key scientific and policy advances that now make it possible for us to end the HIV/AIDS epidemic. Now, it is time to look to the future.

Call for an AIDS-Free Generation

In her November 8^th speech, Secretary of State Hillary Rodham Clinton issued an historic call for U.S. government leadership of worldwide efforts to achieve an “AIDS-free generation” by building on successful investments in HIV prevention, care, treatment and research.

Implementing the National HIV/AIDS Strategy

One of those key “investments” has been the development of the National HIV/AIDS Strategy (NHAS). It has been more than a year since the release of the Strategy, which sets ambitious goals for addressing HIV/AIDS in this country. Since then, there have been community implementation dialogues across the nation and federal agencies have prepared and are now implementing operational plans that detail how they are pursuing the NHAS goals. We encourage you to review those plans, especially those of the Department of Labor and the Social Security Administration.

AIDS 2012 Comes to the United States

For the first time in more than 20 years, the International AIDS Conference returns to the U.S. in July 2012. More than 25,000 people will come to Washington, D.C. from all over the world to share the latest HIV research and engage in dialogue about ending the epidemic. This is an opportunity for the disability community to share lessons learned about the HIV/AIDS epidemic with colleagues from around the world. This week, the U.S. government launched a dedicated webpage for information about the conference.

Observing World AIDS Day

Please take a moment today to honor those lost to HIV/AIDS, celebrate how far we have come in 30 years and rededicate yourself to joining our efforts to achieve the vision of the National HIV/AIDS Strategy and bring about an AIDS-free generation. If you have not decided how to observe the day, here are three simple ideas:

1. Participate in Facing AIDS. For the fourth year in a row, people all over the United States are sharing their messages to end the stigma associated with HIV/AIDS. You can download a sign and write a message about why you are “facing AIDS,” take a picture of yourself holding the sign and upload it to the Facing AIDS gallery.

2. Encourage someone to get an HIV test – and get one yourself. Testing is one of the primary ways to end the spread of HIV, because people who know their HIV status can take measures to protect themselves and their partners. The Centers for Disease Control and Prevention (CDC) estimate that about 240,000 people in the U.S. who are living with HIV don’t know they are infected. Use the HIV/AIDS Prevention and Service Provider Locator to find an HIV testing location near you.

3. Use new media. Follow our AIDS.gov blog – featuring posts from the CDC, Department of Health and Human Services (HHS), National Institutes of Health (NIH) and other federal partners – and tweets from AIDS.gov. Join the conversation on social media by using the hashtag #WAD11 when sharing your thoughts about World AIDS Day on Twitter or Facebook.

We encourage you take time to reflect and take action on World AIDS Day.

As President Obama observed, realizing the vision of the NHAS “will require the commitment of governments at all levels, businesses, faith communities, philanthropy, the scientific and medical communities, educational institutions, people living with HIV and others.” This includes, of course, the disability community, which has been a solid ally in the response to HIV/AIDS for decades.

Dr. Maggie Czarnogorski

In this month during which we observe Veteran’s Day, I am pleased to share news about an a significant achievement in HIV screening at the U.S. Department of Veterans Affairs: Annual HIV testing rates in Veterans Administration Medical Centers increased significantly between 2009 and 2010. As reported in a Research Letter I co-authored with colleagues for the October 24, 2011, edition of the Archives of Internal Medicine , overall, the VA saw a 140% increase in the number of HIV tests conducted from 2009 to 2010. This included a 47% increase in both the proportion of veterans ever tested for HIV (9.2% to 13.5%) and a 132% increase in proportion of veterans tested in the calendar year (2.5% to 5.8%).

These increases make important contributions to the efforts to achieve the goals of the National HIV/AIDS Strategy, reducing the number of new HIV infections, increasing access to care and improving health outcomes for people living with HIV, and reducing HIV-related disparities.

Facilitators

The increase in HIV testing rates at the VA is the result of several recent developments, including:

• After Congressional repeal of long-standing requirements barring widespread HIV testing and requiring written informed consent in VA facilities, in August 2009 the VA aligned its HIV testing policies with the CDC’s 2006 recommendations on HIV testing.  We now offer voluntary HIV testing to all veterans, regardless of age, as part of routine health care at least once, and annually for those veterans with ongoing risk factors. These policy changes also transitioned VA from requiring written informed consent to oral informed consent for HIV testing. VA also no longer requires that patients receive scripted, standardized pre- and post-test counseling before and after HIV testing. These policy changes have a common goal: to diagnose infection as soon as possible so that Veterans can receive state-of-the-art care and remain healthy for many years to come.
• To support this important policy change, VA has undertaken several initiatives to bring the attitudes and practices of both health care providers and veterans along with the policy change:
  • The VA has made use of electronic health records (EHRs) since the 1990s.  We have been able to leverage this system by adding a clinical reminder about HIV testing for providers who treat veterans. It prompts the primary-care provider to conduct HIV screening for any veteran who had not been screened previously.
  • We have also made grants to support HIV testing in many VA medical centers around the country. These have been used to promote testing in various settings such as mental health, women’s health, homeless veterans programs and in facilities of various sizes and types. These grants have promoted the use of rapid HIV testing, facilitated staff training, as well as the development of patient education activities and materials.
  • Finally, the VA has launched a social marketing campaign, Get Checked: Say Yes to the Test, that reaches out to both VA health care providers and veterans to influence their attitudes and behaviors related to routine HIV testing. It includes videos, brochures, and posters to promote the new policy to providers and encouraging veterans to request HIV testing. Among the messages communicated to patients is that neither an HIV test nor its result will affect a veteran’s VA care or eligibility for VA benefits.

Serving More Nearly 6 Million Veterans Each Year

Given that VA serves nearly six million veterans each year (our analysis showed that 5,713,265 veterans had at least one out-patient visit during calendar year 2009, and 5,888,599 had one in 2010), this policy has the potential to reach a significant number of people who are not aware of their HIV status. Moreover, we know that early diagnosis improves the chance of the patient living a long and healthy life and helps limit transmission of HIV to others.  The VA is well positioned to link those who test positive to care as we are the nation’s largest single provider of HIV care. Veterans with HIV infection in VA care receive HIV care at all 152 VA Medical Centers and throughout all 21 of the VA’s Veterans Integrated Service Networks. To date, nearly 64,000 Veterans have received HIV care in the VA, and in 2009, more than 24,000 Veterans with HIV were receiving care at the VA.

In the months and years ahead, we will continue to collect and analyze data and strive to improve HIV testing rates throughout the entire VA system as we work with our partners across the Federal government and throughout the nation to achieve the goals of the National HIV/AIDS Strategy.

This is the final in our series of daily highlights from the U.S. Conference on AIDS, which wrapped up Sunday in Chicago.  In addition to highlights from the final day’s activities, we also wanted to share a short interview with Mr. Jeffrey Crowley, Director of the White House Office of National AIDS Policy, we captured at the conference.

Closing Plenary Luncheon: Looking Forward to 2012

Sunday’s closing plenary session looked forward to some significant opportunities for the HIV/AIDS movement in the near future, including applying recent scientific advances and scaling up treatment as prevention, the 2012 International AIDS Conference, and implementation of the Affordable Care Act and the National HIV/AIDS Strategy.

Dr. J. Montaner addresses USCA

• Dr. Julio Montaner, Director of the British Columbia Centre for Excellence in HIV/AIDS and past president of the International AIDS Society, discussed the idea of treatment as prevention, sharing findings from his research in British Columbia. That research showed that as they expanded the number of HIV positive individuals on highly active antiretroviral therapy (HAART), there was a corresponding reduction the number of new HIV infections. This reduction occurred because, Dr. Montaner explained, HAART stops viral replication, which, in turn, causes HIV levels fall to undetectable levels in blood as well as in sexual fluids making transmission of the virus much less likely.  Dr. Montaner suggested that expanded HAART coverage is now among the strongest tools in the combination prevention toolbox. “This is about treating people who need life saving therapy; but, if we do it right, we can stop the epidemic,” he said. He praised Secretary of State Hillary Clinton’s acknowledgment of treatment as prevention as integral to the global fight against AIDS in her speech last week about creating an AIDS-free generation.

Mr. B. Audoin addresses USCA

• In his remarks, Mr. Bertrand Audoin, Executive Director of the International AIDS Society, looked forward to AIDS 2012, the 19th International AIDS Conference that will be held July 22-27, 2012, in Washington, DC.  He urged USCA conference participants to take full advantage of the international conference returning to the United States for the first time in more than 20 years, noting that the diversity of sessions, speakers, and activities allow many opportunities to learn from and even form partnerships with individuals and organizations working to end the HIV/AIDS epidemic across the globe.  The conference theme, “Turning the Tide Together,” Mr. Audoin observed, reflects the renewed optimism that a change of course in the epidemic is possible due to recent scientific advances in HIV treatment and biomedical prevention, including treatment as prevention, which Dr. Montaner and others discussed at the conference. AIDS 2012 will emphasize solutions and moving new scientific advances to implementation, Mr. Audoin observed.

Dr. M. Wakefield addresses USCA

• Finally, Dr. Mary Wakefield, Administrator of the Health Resources and Services Administration (HRSA), closed the conference with an update on the implementation of the Patient Protection and Affordable Care Act (ACA) and the National HIV/AIDS Strategyacross her agency, which administers programs including the Ryan White CARE Program and the network of federally-supported Community Health Centers. Dr. Wakefield observed that across the several bureaus and offices that comprise HRSA, she and her colleagues are actively involved in the Administration’s efforts to protect the interests of people living with HIV/AIDS (PLWH/A), deliver care to PLWH/A, and improve access to and the quality of HIV care and treatment. She also shared that as we move towards reauthorization of the Ryan White program in 2013, and full-implementation of the ACA one year later, HRSA is hard at work figuring out how the Ryan White program wraps around the Affordable Care Act. Many activities also consistent with the National HIV/AIDS Strategy, she noted, are already underway, including:
  • Studies underway at the HIV/AIDS Bureau looking at the HIV clinician workforce and staffing requirements and the critical problem of retention in treatment.
  • HRSA’s Bureau of Health Professions is working in partnership with 11 universities to develop teaching modules for future clinicians on a host of issues, ranging from HIV in elderly patients and chronic disease management in vulnerable populations to on-site training for medical students in outreach centers for homeless people living with HIV.
  • HRSA’s Bureau of Primary Health Care, which oversees the health center program, is working to expand HIV testing and care across 8,100 clinical sites. They recently reported a 30% increase in the number of individuals screened for HIV over the past year with more than 780,000 people tested at a health center last year.
  • HRSA is also working to assist AIDS Services Organizations and LGBT health clinics with planning grants to help them become health centers. At the same time, it is working with existing health centers to strengthen their capacity to deliver HIV/AIDS specialty care and also better meet the health care needs of the LGBT community through both the activities of the National Center for HIV Care in Minority Communities and a new technical assistance and training center on LGBT health.

In conclusion, Dr. Wakefield urged continued collaborative efforts, “If we are to meet the challenge of achieving and HIV-free generation as Secretary Clinton has challenged the world to do, it is critically important that all of us from local, community, state and Federal levels work as effectively and efficiently as possible to deploy all available resources, seek new opportunities to leverage them, and deliver high quality HIV prevention, care and treatment.”

AIDS 2012 Community Roundtable

Another session Sunday featured an overview of the 2012 International AIDS Conference (AIDS 2012). Both conference organizers and participants in prior conference encouraged USCA participants to take advantage of the global gathering being held in the U.S. for the first time in more than 20 years and plan to attend.  They also offered tips on making the most of the many aspects conference including the presentations on the latest HIV science, poster sessions, the global village, and many other activities being planned. For those who will not be able to travel to Washington, DC for the conference, presenters urged that they consider planning or participating in a hub session , many of which will take place in cities around the world.

Medicaid and Other Safety Net Programs

AIDS.gov also attended the workshop “Why HIV Advocates Should Care: Making Sense of Federal and State Threats to Medicaid and other Safety-net Programs” with presentations by the HIV Medicine Association, Project Inform, and Treatment Access Expansion Project. They highlighted political and economic issues that could impact the Medicaid program and other critical programs supporting health care for people living with HIV/AIDS at the Federal and state levels.  Among the topics discussed was the Pre-existing Condition Insurance Program (PCIP), a temporary high-risk health insurance pool program created by last year’s health care reform law, the Affordable Care Act.  More information about PCIP is available at www.pcip.gov.

Interview with Director Crowley

Finally, AIDS.gov sat down with Mr. Jeffrey Crowley, Director of the White House Office of National AIDS Policy (ONAP) at the U.S. Conference on AIDS to discuss his address to the conference participants, and his thoughts about Secretary Clinton’s recent speech about an AIDS-free generation as well as the 2012 International AIDS Conference.

AIDS.gov team members Miguel Gomez, Aisha Moore, and Robb Nolan contributed to this post.