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What's Really in the President's National HIV/AIDS Strategy?

By L.K. Regan

For the first time, the US has a national strategy for fighting HIV/AIDS. President Obama announced Tuesday a new set of targets in the domestic fight against AIDS. He intends to reach them, however, using the funding already allotted to AIDS prevention. Here’s how he plans to spend the money, and what he hopes to accomplish with it.

For years, HIV infection rates in the US have remained essentially unchanged, hovering around 56,000 new cases per year. Meanwhile, funding for HIV prevention has focused on global rather than domestic efforts. In 2003, President Bush authorized 15 billion dollars dedicated to fighting AIDS in 15 of the hardest-hit countries—which, of course, did not include the US. President Obama’s new national AIDS strategy will not change this situation in terms of absolute dollars: with a huge health-care law recently passed, and a toxic debate raging in Washington, D.C. over deficits, the president has decided, instead of requesting more money, to redirect the 19 billion dollars already dedicated annually  to HIV/AIDS prevention and treatment in the US.

Within that budget, here are the targets set out for 2015 as stated in the strategy:

  1. Reductions in new infections. This includes a 25% reduction from 56,000 annually to 42,225—a substantial goal for five years. Also, to increase to 90% (from 79%) the number of people with HIV who are aware they have the virus. This will come down to testing, testing, testing.
  2. Increasing access to care and improving health outcomes for HIV-positive people. By 2015, the strategy sets the following specific goals: to increase by 20% the number of people who receive care within three months of a diagnosis; to measurably extend the reach of the Ryan White Program (already the largest federal AIDS-specific grant program, with half a million participants annually), both in terms of access to continuous medical care and access to affordable, permanent  housing.
  3. Reducing HIV-related health disparities. HIV disproportionately impacts gay and bisexual men, African-Americans, and Latinos. These populations thus need more outreach and support. The National AIDS Strategy has as a goal a 20% increase in the number of HIV-positive people in each of these populations with an undetectable viral load.
Doing all of this won’t be easy, especially on a limited budget. But the new strategy calls for a redistribution of resources to focus on the communities most at risk—including gay men. For the first time, national policy will reflect the fact that sex between men is the source of more than half of new infections, and will center education, testing and treatment resources within gay communities, as well as in African-American and Latino population centers. The idea is to put resources where they will have the biggest impact, meaning that a city like San Francisco (where 87% of new infections are among gay men) will likely see an increase in resources, whereas cities in the midwest, where infection rates are relatively low, will see a reduction.

The new strategy is the outcome of President Obama's 2008 campaign promise to develop a national plan for fighting AIDS. He delegated a taskforce, which spent over a year investigating the issue. For some activists, the results are encouraging in that they finally offer coordination between federal, state and local organizations: federal agencies will, for the first time, need to work both with each other and with local communities to meet specific targets. As Julie Scofield, executive director of the National Alliance of State & Territorial AIDS Directors, told Reuters in a phone interview, "Right now state health departments and community-based organizations really have so many disparate requirements and rules and reporting that it really ties them up in knots more than it should.“ But for others, the lack of new funding is a deal-breaker. "This strategy is a day late and a dollar short,“ said Los Angeles' AIDS Healthcare Foundation president Michael Weinstein during a news conference. "Fifteen months in the making, and the White House learned what people in the field have known for years. There is no funding, no 'how to,' no real leadership."