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National HIV/AIDS Strategy (NHAS): September 2011 Update

This update provides an overview of the National HIV/AIDS Strategy (NHAS) in the United States, including its vision, goals, and targets for 2015. It also discusses the implementation of NHAS and the challenges faced in the current landscape of budget cuts and disparities. The role of NASTAD in weighing in on NHAS and their recommendations is highlighted.

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National HIV/AIDS Strategy (NHAS): September 2011 Update

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  1. National HIV/AIDS Strategy (NHAS): September 2011 Update

  2. NHAS Vision 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.

  3. NHAS Goals: Targets for 2015 Reducing HIV Incidence • Lower the annual number of new HIV infections by 25 percent • Reduce the HIV transmission rate by 30 percent • Increase the percentage of people living with HIV who know their serostatus from 79 to 90 percent

  4. NHAS Goals: Targets for 2015 Increasing Access to Care and Improving Health Outcomes for People Living with HIV • Increase the proportion of patients linked to care within 3 months of HIV diagnosis from 65 to 85 percent • Increase the proportion of Ryan White HIV/AIDS Program clients in continuous care from 73 to 80 percent • Increase the number of Ryan White clients with permanent housing from 82 to 86 percent

  5. NHAS Goals: Targets for 2015 Reduce HIV-Related Health Disparities • Increase the proportion of HIV diagnosed gay and bisexual men with undetectable viral load by 20 percent • Increase the proportion of HIV diagnosed Blacks with undetectable viral load by 20 percent • Increase the proportion of HIV diagnosed Latinos with undetectable viral load by 20 percent

  6. NHAS Goals: Targets for 2015 Coordination • Increase the coordination of HIV programs across the federal government and between federal agencies and state, territorial, tribal and local governments. • Develop improved mechanisms to monitor and report on progress toward achieving national goals.

  7. NHAS Overview The lead federal agencies submitted operational plans detailing how they will implement the NHAS. They can be found at:http://www.aids.gov/federal-resources/policies/national-hiv-aids-strategy/whats-next/agency-operational-plans.html.

  8. Landscape: Implementing NHAS in Challenging Times • States are struggling and according to the National Association of State Budget Officers and the Association of State and Territorial Health Officials, general fund spending continues to decline. As a result, state health agencies are experiencing budget cuts and job losses. • Federal operating agencies need to embrace the Strategy’s call to achieve a more coordinated response with meaningful community engagement.

  9. Landscape: Implementing NHAS in Challenging Times • New CDC incidence estimates among Black MSM must be a call to action to increase our response in this community. • The ADAP crisis must be addressed.

  10. NHAS Implementation: NASTAD Weighs-in Winter 2010- Spring 2011 • February 2010: NASTAD sends NHAS input letter to Jeff Crowley, Director of the White House Office of National HIV/AIDS Policy.  • 2010: The Institute of Medicine (IOM) holds a series of three workshops on HIV screening and access to care as part of the data gathering for the development of the Strategy. Beth Scalco (LA) and Liisa Randall (MI) represent states as members of the IOM panel. NASTAD Executive Director Julie Scofield presents NASTAD recommendations during the fall 2010 IOM workshop.

  11. NHAS Implementation: NASTAD Weighs-in • July 2010: NASTAD sends a letter to ONAP Director Crowley upon publication of the NHAS offering partnership. • August 2010: NASTAD publishes the Role of States document outlining states’ role in implementing the NHAS. • October 2010: NASTAD weighs in on state plans in its National HIV/AIDS Strategy & Federal Implementation Plan Issues for Consideration document, sent to all federal implementing partners.

  12. NHAS Implementation: NASTAD Weighs-in • October 2010: Julie Scofield presents on state budget cuts and the role of states in implementing the NHAS at a Funders Concerned About AIDS meeting. • November 2010: Julie Scofield presents, Non-Federal Perspective on Funding Formulas and Policies, at an HHS consultation on HIV/AIDS funding formulas and resource allocation.

  13. NHAS Implementation: NASTAD Weighs-in • November 2010: NASTAD attends the ECHPP Grantee Orientation heldfor the 12 grantees funded through PS10-10181 for the Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan Statistical Areas Most Affected by HIV/AIDS (ECHPP) project, a key activity outlined in the NHAS. • January 2011: Julie Scofield represents NASTAD at a meeting on the NHAS convened by the Coalition for a National AIDS Strategy in Los Angeles, CA.

  14. NHAS Implementation: NASTAD Weighs-in • February 2011: NASTAD publishes its United in HIV/AIDS: A Guide to Understanding How Faith Communities Can Make A Difference, another key aspect of the NHAS strategy.   • February 2011: NASTAD releases its policy statement on HIV criminalization in response to the NHAS imperative to examine and report on HIV-sentencing laws, policies and implications for people living with HIV. • February 2011: NASTAD meets with the Bureau of Primary Health Care (BPHC) and the National Association of Community Health Centers (NACHC) on the NHAS and health care reform.

  15. NHAS Implementation: NASTAD Weighs-in • March 2011: NASTAD Executive Committee meets with BPHC staff and Ron Valdiserri to discuss NHAS implementation and federal coordination. • March 2011: Terrance Moore, Director of Policy and Health Equity, represents NASTAD at a meeting on the NHAS implications for LGBT communities convened by HHS. • April 2011: NASTAD shares with its members communications from the HRSA Bureau of Primary Health Care (BPHC) to Primary Care Associations (PCAs) regarding the NHAS.

  16. NHAS Implementation: NASTAD Weighs-in • April 2011: NASTAD surveys members on the level of involvement and collaboration that state HIV/AIDS and viral hepatitis programs have with their state correctional facility counterparts in providing HIV/STD/VH-related services to inmates in prison or in transition. • May 2011: ONAP commissioned the IOM to examine data gaps in monitoring access and quality of HIV care (report expected at the end of 2011). The IOM will examine and provide suggestions on “how to obtain meaningful estimates of access to care and services utilization by people living with HIV.” NASTAD Executive Committee member Carmine Grasso (NJ) is on the IOM panel.

  17. NHAS Implementation: NASTAD Weighs-in • May-June 2011: Natalie Cramer, Associate Director of Prevention, identified to represent NASTAD as liaison to Ron Valdiserri’s office on state plans. • June 2011: Murray Penner, Deputy Executive Director, represents NASTAD at an HHS consultation on Priority Approaches for Use of Potential New NHAS Funding. • June 2011: Julie Scofield, Terrance Moore and Chris Taylor, Senior Manager of Viral Hepatitis, represent NASTAD at a CDC consultation on Prevention Through Health Reform along with NASTAD members Heather Hauck (MD), Kathy Hafford (VA), Jacqueline Clymore (NC), Daniel Daltry (VT), Maria Courogen (WA), and Michelle Roland (CA).

  18. NHAS Implementation: NASTAD Weighs-in • June 2011: NASTAD sends a letter to ONAP Director, Jeff Crowley, around the on-going state plans discussions and conveying thoughts based on conversations with many state AIDS directors. • June 2011: Julie Scofield, Natalie Cramer, Randy Mayer (IA), Kathy Hafford (VA) and Heather Hauck (MD) discuss perspectives on state plans at an OMB/White House meeting on the development of state plans. • June 2011: CDC Prevention Funding Opportunity Announcement (FOA) is released.

  19. NHAS Implementation: NASTAD Weighs-in • July 2011: NASTAD co-sponsors workshop on Modeling and Evidence Based Decision Making with amfAR, Kaiser Family Foundation, The Foundation for AIDS Research and the Urban Coalition for HIV/AIDS Prevention Services. • July 2011: Terrance Moore represents NASTAD at an HHS consultation with persons living with HIV/AIDS. • August 2011: Julie Scofield participates in plenary panel on the NHAS at the National HIV Prevention Conference in Atlanta.

  20. NHAS Implementation: NASTAD Weighs-in • September 2011: Natalie Cramer, Randy Mayer (IA), Ann Robbins (TX), Liisa Randall (MI) and Hope Cassidy-Stewart (MD) participate in an HHS meeting on determining indicators to determine NHAS success. Ongoing/Future • NASTAD will continue to provide regular communication to members via email memos updating them on NHAS. • NASTAD is in regular phone and email communications with HHS Deputy Assistant Secretary for Health, Infection Diseases, Ron Valdiserri, who has been tasked with leading the development of NHAS implementation plans.

  21. NHAS Implementation: NASTAD Weighs-in • NASTAD provides technical assistance to members in their implementation of CDC FOA upcoming projects. • NASTAD intends to continue its strong participation in NHAS implementation discussions and activities and to support ongoing and frequent communication with and from members on the NHAS.

  22. Federal Response: ONAP Office of National AIDS Policy – is conducting a series of regional dialogues on implementation of the NHAS. These 5 dialogues have taken/ will take place in: • Alabama - September 27, 2011 • Seattle - October 4, 2011 • Philadelphia - October 20, 2011 • Louisiana - October (date TBD) • Iowa - November (date TBD)

  23. Federal Response: PACHA President’s Advisory Committee on HIV/AIDS (PACHA) – In an effort to support NHAS implementation, PACHA has created several subcommittees to address key areas of the NHAS (e.g., Incidence and Health Disparities Subcommitees).  Additionally, PACHA has gone on record, supporting a variety of resolutions around access to care and a letter to President Obama supporting the restoration of funding to core HIV prevention programs through CDC’s Health Department FOA.

  24. Federal Response: HHS HHS: 12 Cities – The 12 Cities Project builds upon the CDC’s grants for Enhanced Comprehensive HIV Prevention Plans (ECHPP) and supports a coordinated response to HIV/AIDS prevention, care and treatment activities in the 12 U.S jurisdictions that bear the highest AIDS burden (Atlanta, Baltimore, Chicago, Dallas, District of Columbia, Houston, Los Angeles, Miami, New York City, Philadelphia, San Juan (Puerto Rico) and San Francisco).

  25. Federal Response: HRSA HRSA- Bureau of Primary Healthcare (BPHC) • January 2011: Held a grantee technical assistance call to explore how Health Centers can respond to the NHAS and expand their involvement in HIV/AIDS care and activities. • June 2011: Announced the release of Program Assistance Letter (PAL) 2011-06, HIV/AIDS Care and Treatment in Health Centers. The PAL outlines BPHC’s expectations regarding the increased integration of HIV/AIDS services across the Health Center Program, reviews key guidelines and protocols and identifies opportunities for technical assistance.

  26. Federal Response: CDC The CDC released its 5 year Funding Opportunity Announcement (FOA) in the Summer of 2011. The FOA includes three categories of funding: • Category AHIV Prevention Programs for Health Departments (required); Category BExpanded HIV Testing for Disproportionately Affected Populations (limited eligibility) and; Category CDemonstration Projects (optional and competitive). • NASTAD, UCHAPS, PACHA and the Prevention Justice Alliance have gone on record asking for the restoration of funds to Category A and B of the FOA equal to amounts available in FY2010.

  27. Federal Responses: DOL Department of Labor – In April 2011, DOL convened an HIV/AIDS Roundtable to explore ideas for improving employment opportunities and outcomes and reducing stigma and discrimination for people living with HIV/AIDS. To view the Summary of Proceedings, please go to: http://www.dol.gov/odep/pdf/20110408.pdf.

  28. Federal Responses: DOJ Department of Justice – In an effort to support the NHAS’ call to reduce stigma and discrimination, the Justice Department sent a letter to the attorneys general of all 50 states and territories to request their assistance in addressing the illegal exclusion of individuals with HIV/AIDS from occupational training and state licensing.

  29. Federal Response: HUD Department of Housing and Urban Development – HUD recently awarded $8.8 million in projects through the Housing Opportunities for Persons with AIDS (HOPWA) program to fund seven cities and states that will offer permanent and transitional housing and support services to more than 200 households with families and individuals living with HIV/AIDS.

  30. Federal Response: SAMHSA SAMHSA – SAMHSA has a new strategic plan that aims to improve the nation’s behavioral health, transform healthcare in America, and achieve excellence in operations. SAMHSA also administers the Substance Abuse Prevention and Treatment Block Grant (SAPT) and is looking for ways to develop a strategy for updating the funding criteria that allow States to use SAPT funds for HIV/AIDS services.

  31. Federal Response: SSA Social Security Administration – SSA is using a three-part strategy to improve the lives of people living with HIV/AIDS by: 1) conducting program outreach to at-risk communities; 2) updating policy to make faster, more accurate disability determinations and decisions; and 3) assisting people who are already on disability rolls with returning to work.

  32. Federal Response: VA U.S Department of Veterans Affairs– The VA began routine HIV testing rather than risk-based testing and removed the previous requirement of written informed consent from their policy. As a result, they have had an increase of 140% in testing from 2009.

  33. Year 2: 2012 and Beyond Looking ahead: • HHS is working with key stakeholder to determine common metrics/indicators in measuring success. • State health departments will be implementing the new CDC FOA. • Reporting requirements (98 and counting): Refine, Reduce and Harmonize. The federal operating agencies must embrace the NHAS’ call to achieve a more coordinated response.

  34. Year 2: 2012 and Beyond • NASTAD will continue to advocate for the protection of current funding and increases in resources to carry out the goals of the NHAS. • The NHAS can only be achieved if state and local health departments, community stakeholders and federal partners are working in harmony in terms of coordination, communication and implementation. • Overall, community engagement and collaboration will be critical in the success of the NHAS. Especially as it pertains to engaging youth who are increasingly contracting HIV.

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