Image by the Center for Disease Control and Prevention
Today, in conjunction with World AIDS Day, the White House Office of National AIDS Policy is releasing the Federal Action Plan for 2016-2020, which outlines specific Federal agency actions to implement the updated National HIV/AIDS Strategy next year and through 2020. This Federal Action Plan, along with our updated National HIV/AIDS Strategy, and continued investments in the President’s Emergency Plan for AIDS Relief (PEPFAR), underscores the Administration’s commitment to an reaching an AIDS-free generation.
Globally, though prevention, treatment, and care have significantly improved, nearly 37 million people are living with HIV, including 1.2 million in the United States, and too many have not been diagnosed, are not in medical care, and are not virally suppressed. Despite our scientific advances in HIV treatment for individual and public health benefits, and prevention options like pre-exposure prophylaxis (PrEP), too many lack access to life-saving and life-enhancing services. Moving forward, President Obama and the Administration will continue to build on scientific and technological advances to expand access to prevention options and care.
U.S. Leadership around the World
Since 2003, PEPFAR has continued to scale up HIV prevention, care, and life-saving treatment services for men, women, and children around the world. Through PEPFAR, the U.S. government has invested $65 billion dollars, including nearly $50 billion since the beginning of the Obama Administration, and we’ve made tremendous progress in scaling up treatment and prevention. PEPFAR’s success is measured in lives improved and saved. This year, PEPFAR is making great progress toward meeting these targets by:
o Supporting life-saving antiretroviral treatment for 9.5 million men, women, and children worldwide (of these, 5.7 million are receiving direct support and an additional 3.8 million are benefiting from essential technical support to partner countries).
o Supporting more than 8.9 million voluntary medical male circumcision procedures in Eastern and Southern Africa to reduce the risk of HIV transmission.
o Providing care and support for more than 5.5 million orphans and vulnerable children in Fiscal Year 2015.
o Supporting training (including pre-service training) for more than 190,000 new health care workers in PEPFAR-supported countries to deliver HIV and other health services.
o Supported HIV testing and counseling for more than 68.2 million people in FY 2015, providing a critical entry point to prevention, treatment, and care.
o Supported HIV testing and counseling for more than 14.7 million pregnant women in FY 2015. For the 831,500 of the women who tested positive for HIV, PEPFAR provided antiretroviral medications to prevent mother-to-child transmission of the virus. Due to PEPFAR support, 267,000 babies that would otherwise have been infected were born HIV-free in FY 2015 alone.
At the 2015 United Nations General Assembly Sustainable Development Summit, the United States committed with global partners to end the epidemic of AIDS by 2030, and President Obama announced bold new PEPFAR treatment and prevention targets for 2016 and 2017:
o By the end of 2016, PEPFAR and partners will support 11.4 million men, women, and children on antiretroviral treatment;
o By the end of 2017, PEPFAR and partners will support 12.9 million men, women, and children on antiretroviral treatment.
o By the end of 2016: Provide 11 million voluntary medical male circumcisions, cumulatively.
o By the end of 2017: Provide 13 million voluntary medical male circumcisions, cumulatively.
o By the end of 2016: Achieve a 25% decrease in HIV incidence among adolescent girls and young women (aged 15-24) within the highest burden geographic areas of 10 sub-Saharan African countries jointly with partners.
o By the end of 2017: Achieve a 40% decrease in HIV incidence among adolescent girls and young women (aged 15-24) within the highest burden geographic areas of 10 sub-Saharan African countries jointly with partners.
Implementing our National HIV/AIDS Strategy through 2020
The United States is home to over a million people living with HIV, many of whom face stigma and discrimination which prohibits access to care and prevention services. In 2010, President Obama released our first comprehensive National HIV/AIDS Strategy, and in July of this year, our National HIV/AIDS Strategy: Updated to 2020 to continue our sharp focus on reducing new HIV infections, improving access to care and improving health outcomes, reducing HIV-related health disparities, and achieving a more coordinated national response.
Though challenges remain, we’ve made significant progress over the last five years, including:
- Increasing the percentage of people living with HIV who are diagnosed from 81 to 87%;
- Eliminating the AIDS Drug Assistance Program waiting lists;
- Increasing focus and funding on most-affected populations through CDC’s High Impact Prevention;
- Enriching our knowledge about HIV prevention, treatment and care through groundbreaking research funded by the National Institutes of Health, especially related to “treatment as prevention” and pre-exposure prophylaxis;
- Modernizing our Federal HIV testing and treatment guidelines;
- Implementing the Affordable Care Act, which has allowed millions of Americans to access health coverage and benefit from access to preventive services such as HIV testing without cost sharing;
- Fighting stigma and addressing discrimination through the Department of Justice, and improving access to employment and housing services through the Department of Labor and Department of Housing and Urban Development.
Action at the Federal Level
Today, we are releasing the Federal Action Plan for 2016-2020, which outlines specific Federal agency actions to implement the Strategy next year, and through 2020. In addition to the ongoing, daily work by Federal agencies, included in the Federal Action Plan are 170 action items that agencies will undertake over the next five years. Some of the action items include:
· To improve widespread HIV testing and linkage to care:
o The Center for Medicare and Medicaid Services will provide information to State Medicaid Directors on the latest treatment guidelines, scientific advances in prevention, and program flexibility available for increased access to testing and improved care coordination.
o The Centers for Disease Control and Prevention (CDC) will establish new standards for linkage to care (within 1 month of diagnosis) for all new funding announcements and demonstration projects.
o CDC will collaborate with the Health Resources and Services Administration (HRSA) to assess and identify ways to increase HIV testing among patients in health centers who are diagnosed with acute sexually transmitted infections, an important indicator of risk for HIV infection.
· To improve broad support and attain universal viral suppression for people living with HIV:
o CDC will scale up use of the Data to Care public health strategy, which uses HIV data to identify those not in care, by including use of the strategy in all relevant HIV funding opportunities.
o HRSA, in consultation with CDC, will develop a Data to Care learning collaborative across communities served by the Ryan White program to share effective models for addressing gaps along the HIV care continuum.
o HUD will work to improve the ability of HUD-funded “Continuums of Care” to identify homeless persons living with HIV and link them to housing assistance, medical care, and other services.
· To improve full access to comprehensive PrEP services:
o CDC will increase awareness and uptake of PrEP by rapidly disseminating lessons learned from demonstration projects and implementation research.
o Agencies including HRSA, HHS Office of Minority Health, SAMHSA, Indian Health Services, and Department of Veterans Affairs, will disseminate information and provide education about PrEP to their award recipients and service providers in order to improve access and increase uptake.
o HHS will develop an inventory of current, federally-funded PrEP programs, policies, research, and technical assistance activities, and conduct a gap analysis to identify high-priority research and policy needs, as well as potential geographic and population targets where PrEP access should be scaled up.
· To reduce discrimination against people living with HIV:
o The Department of Justice (DOJ) will continue to open new investigations, as appropriate, of HIV/AIDS discrimination under the Barrier-Free Health Care Initiative, as well as under the Fair Housing Act to address discrimination by housing providers.
o The Equal Employment Opportunity Commission will educate job applicants and employees living with HIV of their employment non-discrimination rights by developing materials for distribution through new channels, including health care delivery sites.
o DOJ will send to all State Attorneys General, its Best Practices Guide to Reform HIV-Specific Criminal Laws to Align with Scientifically Supported Factors, with a cover letter alerting them to its purpose and contents.
Action at the State and Local Levels
Since taking office, President Obama has said that achieving an AIDS-free generation will take more than the Federal government. The National HIV/AIDS Strategy is a national roadmap, not just a Federal one, and states, cities, and communities are committing to implement the updated Strategy and meet its 2020 goals.
In addition, several U.S. cities have signed on to the Fast Track Cities Initiative, a global framework for local jurisdictions to commit to accelerating their responses to their local HIV epidemics. Today, the mayors of Washington, D.C., Baltimore, and Providence have committed their cities to accelerate efforts to reach the UNAIDS 90-90-90 goals by 2020. The 90-90-90 goals are to achieve 90% diagnosis rate among people living with HIV, achieve 90% treatment rate among those diagnosed, and achieve 90% viral suppression rate among those on treatment. The full list of U.S. cities now includes:
· San Francisco, California
· Miami, Florida
· Oakland, California
· Atlanta, Georgia
· Denver, Colorado
· Washington, District of Columbia
· Baltimore, Maryland
· Providence, Rhode Island
Finally, at CDC’s National HIV Prevention Conference in Atlanta on December 6, the Office of National AIDS Policy will release a Community Action Framework to accompany the Federal Action Plan as a tool for community organizations to ensure their priorities and programs align with our national goals, priorities, and outcomes. Because the updated National HIV/AIDS Strategy is not just a Federal plan, the Community Action Framework will assist community organizations in developing plans similar to the Federal Acton Plan.