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White House Releases Updated National HIV/AIDS Strategy

On July 30 the White House released an updated version of its National HIV/AIDS Strategy, outlining the administration's plans through the year 2020. In keeping with recent research, the revised strategy includes an increased emphasis on early antiretroviral treatment and pre-exposure prophylaxis (PrEP), as well as focusing on underserved and heavily affected population groups including young gay men, transgender women, and African-Americans.

President Obama released the strategy update with an executive order, launching it at an all-day event at Morehouse School of Medicine in Atlanta -- a city that represents the burgeoning HIV epidemic in the south.

"Prevention, treatment and care have saved millions of lives, even in the world’s poorest countries," Obama said at the launch. "But our work is far from finished. 1 in 8 people with HIV still go undiagnosed. Only 3 in 10 people with HIV have suppressed the virus in their system, lowering it to an undetectable level. And this disease still affects different ages, races, sexual orientations, and even different regions of the country in disproportionate ways."

"We’ve come a long way in the fight against AIDS -- and we can’t let up now," he continued. "For those whose lives are still at risk, and for those who didn’t live to see this moment, let’s keep working for an AIDS-free generation."

First released in 2010, the National HIV/AIDS Strategy [NHAS] has 4 key goals:

• Goal 1: Reducing New HIV Infections
• Goal 2:Increasing Access to Care and Improving Health Outcomes for People Living with HIV
• Goal 3:Reducing HIV-related Disparities and Health Inequities
• Goal 4:Achieving a More Coordinated National Response

The strategy aims to coordinate the efforts of the multiple federal government agencies that play a role in the fight against HIV/AIDS, including the White House Office of National AIDS policy (ONAP) and the Department of Health and Human Services -- which oversees the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH) -- as well as the Departments of Defense, Justice, Labor, Education, and others.

The updated strategy incorporates advances in scientific research and policy over the past 5 years, which includes studies showing the benefits of early antiretroviral therapy for everyone diagnosed with HIV (e.g., the START trial), treatment as prevention (HPTN 052 and others), and PrEP (including iPrEx, Partners PrEP and TDF2, and PROUD and Ipergay).

Based on such findings, the strategy calls for efforts at every step of the cascade of care -- and even before that, to prevent HIV infections in the first place.

• Widespread HIV testing and linkage to care
• Broad support for people living with HIV to remain engaged in comprehensive care
• Universal viral suppression
• Full access to comprehensive pre-exposure prophylaxis (PrEP) services

To accomplish the latter goal, the strategy suggests that a PrEP drug assistance program, along the lines of the AIDS Drug Assistance Program, may be in the works.

While implementation of early treatment and biomedical prevention has already led to progress in some areas, others lag behind, and the strategy increases the focus on populations most heavily affected by HIV in the U.S., setting goals to reduce or eliminate disparities by 2020:

Gay, bisexual, and other men who have sex with men of all races and ethnicities, noting the high burden of HIV among black gay and bisexual men

• Black women and men
• Latinos and Latinas
• People who inject drugs
• Youth aged 13 to 24 years, noting the high burden of HIV among young black gay and bisexual men
• People in the southern United States
• Transgender women, noting the high burden of HIV among black transgender women

The updated strategy also takes into account the Affordable Care Act, implemented since the original 2010 strategy, which has increased the number of Americans -- including people living with and at risk for HIV -- who have access to health care coverage.

Response to the Strategy

Response to the updated National HIV/AIDS Strategy has generally been positive, though stakeholders have emphasized the need for action -- and the funds to carry it out -- and not just talk.

"The updated NHAS comes on the heels of important clinical trial findings confirming the significant benefits of antiretroviral drugs for HIV treatment and prevention," said HIV Medicine Association chair Adaora Adimora. "This evidence must drive the NHAS and move us to ensure access to HIV prevention, care and treatment for all people with HIV -- regardless of who they are or where they live."

"While scientific advances inspire optimism, the path forward is complicated by stigma, discrimination, complex social factors, challenges to the ACA and Medicaid, and federal budget austerity measures," she continued. "Limited access to and poor uptake of approved medications for HIV prevention, late HIV diagnosis, late entry into care, and poor retention in care significantly hamper our ability to decrease new infections and achieve the optimal outcomes we all want for people already living with HIV."

Recognizing the 50th anniversary of Medicaid and Medicare, Adimora emphasized the importance of expanding Medicaid in the states that have not yet done so, many of which have a high burden of HIV/AIDS.

"Over the last 5 years, the field of HIV has experienced breakthrough advances in testing, prevention, and access to treatment," San Francisco AIDS Foundation CEO Neil Giuliano concurred. "Since the first National HIV/AIDS Strategy was released, we’ve learned that early treatment gives people better health outcomes, that treatment equals prevention, and that PrEP works. HIV remains a major health issue in our country and the Update -- reflecting hard work and national leadership -- leverages new evidence and acknowledges the vast work still to be done."

7/31/15

Sources

The White House. The National HIV/AIDS Strategy: Updated to 2020. Released July 30, 2015.

The White House. FACT SHEET: The National HIV/AIDS Strategy: Updated to 2020. July 30, 2015.

HIV Medicine Association. Statement from HIVMA Chair Adaora Adimora, MD, MPH on the Release of the Updated National HIV/AIDS Strategy and the 50th Anniversary of Medicaid and Medicare. Media statement. July 30, 2015.

San Francisco AIDS Foundation. National HIV/AIDS Strategy Update Acknowledges Advances; Need for More Coordinated National Response.Press release. July 30, 2015.