To end AIDS in the United States, stay true to the National HIV/AIDS Strategy

Ten years ago, hundreds of organizations and individuals signed a petition calling on all presidential candidates to create a national AIDS strategy. We knew the approach to HIV in the U.S. had to change. The national HIV response we saw was a patchwork: uncoordinated, without clear goals, underinvested where the challenge was most acute, with interventions delivered well below the scale necessary for impact. And the science of HIV prevention was changing dramatically without sufficient efforts to put it into practice.

By the end of 2007, most presidential candidates, including John McCain, Hillary Clinton and Barack Obama, had accepted the challenge to create a strategy. In June 2010, President Obama issued the first comprehensive National HIV/AIDS Strategy for the United States.

Five things we learned from implementation of the National HIV/AIDS Strategy:

1) A commitment to being strategic provides political cover to do tough things.

The Strategy itself was full of smart analysis of the epidemic and laudable goals, but its real impact came in how it was used. With strong leadership by Jeff Crowley, head of the White House Office of National AIDS Policy (ONAP), and his deputy Greg Millett, a series of epidemiologically necessary but politically challenging policy innovations were undertaken, each justified by the new Strategy.

This included:

  • Increased investment in HIV prevention for gay men, which had been seriously under-financed relative to that population’s share of the epidemic.
  • A new, “high impact” approach to HIV prevention emphasizing evidence-based programming at scale.
  • Reallocation of funds to areas of the country most affected by HIV.
  • Streamlining of data reporting to track progress more effectively.

A new emphasis was placed on federal agency coordination that has shown some success and remains a work in progress, as well on the most affected communities, which are now at the leading edge of progress in the U.S. response.

2) Changing the conversation is important, and it’s just the first step.

The Strategy helped put the domestic epidemic back on the radar and galvanized the AIDS services community around a new approach to tackling the epidemic focused on epidemiologic impact. Beyond assuring the availability of services, the focus shifted to outcomes, and people asked how a policy would lead to accomplishing the Strategy’s prevention and treatment targets. Conversely, observing that an approach would fail to advance the Strategy’s goals was now a tool to fight bad policy. Using the “care continuum” as a framework for assessing service delivery helped bring focus to the Strategy goal of greater equity.

3) It matters that the effort grew from the community.

We wanted the White House to own the Strategy because we wanted the government to be responsible for follow-through. But it all started with the community. And that meant that AIDS service organizations were ready to engage creatively with the government when the nation embarked on a more outcomes-oriented approach full of hard choices. As the Strategy said, “The job…does not fall to the federal government alone…. Success will require the commitment of all parts of society[.]”

4) It takes amazing science and the commitment to deliver its results to everyone.

The outcomes of HIV/AIDS research have been phenomenal, turning a deadly disease into a chronic, manageable condition in the space of a couple decades. When we were working on the strategy effort, we had inklings of the potential efficacy of “treatment as prevention” and pre-exposure prophylaxis (PrEP) to prevent both transmission and acquisition of HIV.

When rigorous, multi-site clinical trials proved these approaches did work, it changed what was considered possible, and scientific and policy leaders in the U.S. and around the world now said we had the opportunity to “end AIDS.” Soon, in places such as New York and San Francisco, activists, scientists and public health officials took up the challenge to end the epidemic and “get to zero” with localized, evidence-based, multi-sectoral strategies — an effort that has now expanded across the country.

5) Effective interventions are necessary, but not sufficient.

We recently received welcome news about an overall reduction in HIV incidence in the U.S. But, disparities embedded in that reduction are stark: infection rates actually increased among gay men aged 25-34 and among Latino gay men of all ages. And, the severe, disproportionate burden on black gay men and black heterosexual women continues. Without health systems that can reach everyone and greatly expanded efforts to equalize education, economic opportunity and combat racism, sexism, homophobia and transphobia in our country, we will not end AIDS.

 

Collective Progress and Now a Precipice

Ten years after the strategy effort started, we celebrate our collective progress, but know we are at a precipice. Recent advances will be squandered if Congress and the administration retreat on the ACA and other policy achievements, making it harder for people living with or at risk of HIV to get the services they need to stay alive and healthy. That is why we need federal policy that protects and fully implements the ACA, as well as investments in the CARE Act, HIV prevention at the Centers for Disease Control and Prevention, the Housing Opportunities for People Living With AIDS Act and the National Institutes for Health’s comprehensive HIV/AIDS research program. We also need a strong ONAP to drive and coordinate these vital programs.

The National HIV/AIDS Strategy brought us a vision of a time when HIV infection is rare and everyone living with HIV has access to lifesaving care unfettered by stigma and discrimination. We must remain committed to that vision, for everyone. We need leadership at every level to do what the science tells us we can do: end AIDS in America.

 

The authors of this article are the Original Conveners of the Coalition for a National AIDS Strategy

 

One Comment on “To end AIDS in the United States, stay true to the National HIV/AIDS Strategy”

  1. AIDS does not exist!
    This statement will certainly irritate you and you think we are crazy. But we are not crazy. AIDS is an invention of the pharmaceutical industry. But you can also check our claim yourself. Go to a doctor or professor. Then ask the doctor or professor that he shows you an HIV virus. Ask the doctor or professor to define HIV precisely. You will not receive an exact response. Why? There is no HIV virus.
    These are diseases that consist of many viruses. It can be a simple, single virus or several viruses of different pathogens that strain the body because a weakened immune system can not fight this virus attack well. Worldwide diagnoses are now being invented, on behalf of the pharmaceutical industry. The doctor then gives you special pharmaceuticals. These pharmaceuticals help to further weaken the immune system. Thus, a new disease has been created, which is not exist, and is then called AIDS.
    The so-called special AIDS drugs now ensure that in an foreseeable time the immune system is no longer able to maintain the body functions and the alleged AIDS sufferer then dies. Thus the statement of an immune weakness is completely correct, however, an artificially generated. So-called AIDS sufferers who had not taken these drugs and merely changed their lifestyle were healthy. How can that be? AIDS is exclusively a business, a business with billions of profits. It is a perfect staging for high profits. The dead is pre-programmed, but only if you trust your doctor and the pharmaceutical industry.
    The Dayeng Foundation therapy center was founded by Prof. Lupus Dayeng in 2001. Prof. Dayeng had researched the causes of various diseases for many years. Especially with the so-called AIDS, he has found out the true background. We are able to cure you in a short time. We can even guarantee this, to a high percentage. Since the year 2001, we have liberated all patients who came to us from this fake disease AIDS.
    Decide for yourself. You can only win, because what do you lose? We are looking forward to hearing from you. The pharmaceutical industry will kill you 100%, sooner or later. We would like to point out that we are serious doctors and therapists and we are very well aware of the serious issue.
    We are not to blame for the fact that most of the so-called AIDS sufferers were mostly unilaterally informed and trusted only by a given path which almost always brings them dead. For many people it is easier to trust a system that, with the help of the mainstream media, makes people sick and then keeps them sick. With sick people, an industry can make such unimaginably high profits.
    Although no one loses something through an alternative therapy, most people trust this industry blindly. This is manipulation in perfection. However, there is another way that we would like to show you. Hollywood stars have also been treated by us and have returned to the film business.
    We will be pleased to provide you with further information. A corresponding film, in which many other specialists and scientists can be heard, can be found on our website: http://www.lupus-trust.net
    Dr. Johann Menser
    Therapy Center of the Dayeng Foundation

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