White House Launches Updated National HIV/AIDS Strategy

By Eric Brus

On July 30, the U.S. White House issued a new strategic document to guide the U.S. HIV/AIDS response for the next five years. The 74-page National HIV/AIDS Strategy: Updated to 2020 builds on the goals and accomplishments of the original National HIV/AIDS Strategy (NHAS), which was launched in 2010. According to the new NHAS's Executive Summary, the updated strategy also responds to a number of key developments during the past 5 years.

These include:

� Implementation of the Affordable Care Act;
� Important research indicating that beginning HIV treatment early when a person's CD4 T-cell counts are still high both improves health outcomes for people living with HIV and dramatically reduces their risk of transmitting the virus to others;
� Introduction of PrEP (pre-exposure prophylaxis), which can help HIV-uninfected persons greatly reduce their risk of becoming infected;
� Adoption of new testing technologies that enhance the ability to diagnose HIV soon after infection;
� Funding increases for the AIDS Drug Assistance Program (ADAP), which helps ensure that people living with HIV have access to lifesaving antiretroviral treatment;
� Increased collaboration across Federal government agencies to coordinate HIV/AIDS-related programs and recommendations and to establish core indicators that support sharing data and evaluating progress toward NHAS goals.

The updated NHAS is built around four goals and a series of steps needed to meet them. These are outlined below:

Goal 1: Reducing New HIV Infections

� Step 1.A: Intensify HIV prevention efforts in the communities where HIV is most heavily concentrated.
� Step 1.B: Expand efforts to prevent HIV infection using a combination of effective evidence-based approaches.
� Step 1.C: Educate all Americans with easily accessible, scientifically accurate information about HIV risks, prevention, and transmission.

Goal 2: increasing Access to Care and Improving Health Outcomes for People Living with HIV

� Step 2.A: Establish seamless systems to link people to care immediately after diagnosis, and support retention in care to achieve viral suppression that can maximize the benefits of early treatment and reduce transmission risk.
� Step 2.B: Take deliberate steps to increase the capacity of systems as well as the number and diversity of available providers of clinical care and related services for people living with HIV.
� Step 2.C: Support comprehensive, coordinated, patient-centered care for people living with HIV, including addressing HIV-related co-occurring conditions and challenges meeting basic needs, such as housing.

Goal 3: Reducing HIV-Related Disparities and Health Inequities

� Step 3.A: Reduce HIV-related disparities in communities at high risk for HIV infection.
� Step 3.B: Adopt structural approaches to reduce HIV infections and improve health outcomes in high-risk communities.
� Step 3.C: Reduce stigma and eliminate discrimination associated with HIV status.

Goal 4: Achieving a More Coordinated National Response to the HIV Epidemic

� Step 4.A: Increase the coordination of HIV programs across the Federal government and between Federal agencies and state, territorial, tribal, and local governments.
� Step 4.B: Develop improved mechanisms to monitor and report on progress toward achieving national goals.
For a more detailed but still relatively brief summary of the updated NHAS goals and steps, please see the "Actions-at-a-Glance" sections on pages 8 through 11 of the updated strategy.

Ten Indicators to Track Progress

The updated NHAS also includes the following 10 indicators that can be used to monitor progress toward these goals:
1) Increase the percentage of people living with HIV who know their serostatus to at least 90%.
2) Reduce the number of new diagnoses by at least 25%.
3) Reduce the percentage of young gay and bisexual men who have engaged in HIV-risk behaviors by at least 10%.
4) Increase the percentage of newly diagnosed persons linked to HIV medical care within one month of their HIV diagnosis to at least 85%.
5) Increase the percentage of persons with diagnosed HIV infection who are retained in HIV medical care to at least 90%.
6) Increase the percentage of persons with diagnosed HIV infection who are virally suppressed to at least 80%.
7) Reduce the percentage of persons in HIV medical care who are homeless to no more than 5%.
8) Reduce the death rate among persons with diagnosed HIV infection by at least 33%.
9) Reduce disparities in the rate of new diagnoses by at least 15% in the following groups: gay and bisexual men, young Black gay and bisexual men, Black females, and persons living in the Southern U.S.
10) Increase the percentage of youth and persons who inject drugs with diagnosed HIV infection who are virally suppressed to at least 80%.
In late August, the White House issued a 24-page Indicator Supplement to the NHAS Update. The supplement provides detailed information on each of the 10 quantitative indicators described above, including annual targets leading up to 2020, as well as information about the rationale, data sources, and measures used for each.