HIV/AIDS national policy unveiled

Washington -- The Obama administration has issued the first-ever national strategy on combating and preventing HIV and AIDS.

The policy -- while acknowledging the need for additional resources -- emphasizes better coordination of existing efforts and establishes three other goals: reducing HIV infections, providing better care for HIV-positive people and reducing health disparities. President Obama said the nation has learned much about fighting HIV/AIDS in the last 30 years but that it still needs to treat HIV-positive people much more equitably to combat the disease.

"When a person living with HIV/AIDS is treated as if she's done something wrong, when she's viewed as being somehow morally compromised, how can we expect her to get tested and disclose her diagnosis to others?" Obama asked.

The White House National HIV/AIDS Strategy, announced July 13, sets forth specific goals, including lowering new HIV infections by 25% by 2015. It seeks to achieve this goal both by focusing preventive efforts on communities with the highest HIV infection rates and implementing a national education campaign about the threat of the virus and how to prevent spreading it.

The national policy includes harm reduction strategies, such as needle exchanges. Congress and Obama ended the 21-year-old ban on federal funding for syringe exchange programs in December 2009.

The national policy is historic in that advocates have been calling for it for decades, but the Obama administration was the first to act, said Janet Weinberg, chief operating officer of Gay Men's Health Crisis, an HIV/AIDS advocacy organization in New York City. More than 576,000 people in the U.S. have died from the virus and more than 1 million people have been infected, including about 56,000 new cases each year, according to the Centers for Disease Control and Prevention.

The policy's goals are not overly ambitious, said Georges Benjamin, MD, executive director at the American Public Health Assn. But "this is going to require additional funding to make this work," he said.

The U.S. spends more than $19 billion annually on HIV prevention, care and research, according to the White House. The Obama administration is providing an additional $30 million to help carry out the new national policy and has proposed small budget increases for domestic HIV/AIDS programs in the last two years. However, the policy says any new federal spending is likely to be limited.

The American Medical Association supports the creation of a national HIV/AIDS policy, said AMA Board Chair Ardis Dee Hoven, MD. "We applaud this move toward a more coordinated, accountable and outcomes-oriented response to reduce HIV/AIDS infections and increase preventive efforts and access to health care."

The American College of Physicians also supports the White House HIV/AIDS strategy, ACP President J. Fred Ralston Jr., MD, wrote on July 19. ACP guidelines recommend routine HIV screening for everyone older than 13, with more frequent testing for those at higher risk.

A key to combating the problem is the normalization of testing, Dr. Benjamin said. This test should be no different from getting a cholesterol or blood sugar screening, and public education campaigns also need to be more sustained. Some previous efforts lasted only a few weeks, he said.

Public concern about HIV/AIDS has waned as treatments have reduced it to a chronic disease, Dr. Benjamin said. In 1995, 44% of Americans said HIV/AIDS was the country's most urgent health problem, but only 6% said so in 2009, according to a Kaiser Family Foundation national survey released in April of that year.

Federal efforts on HIV/AIDS have not always been well-coordinated among the more than 30 agencies receiving such funding, Weinberg said. For example, Gay Men's Health Crisis has to report information in different formats to the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, and state and local agencies. This requires staff time that could be used for other purposes, Weinberg said. She suggested that agencies standardize their reporting requirements.

The national policy incorporated public input. The White House Office of National AIDS policy held 14 community discussions and conversations with more than 4,200 people. People submitted more than 1,000 recommendations to the White House website.