#AIDSFREEGENERATION

Global

Pepfar

The vision for this blueprint is simple: Scientific advances and their successful implementation have brought the world to a tipping point in the fight against AIDS. The United States believes that by making smart investments based on sound science, and a shared global responsibility, we can save millions of lives and achieve an AIDS-free generation.


Our Global Principles

To fulfill this vision, the blueprint is based on following principles:

>> Make strategic, scientifically sound investments to rapidly scale-up core HIV prevention, treatment and care interventions and maximize impact.

>> Work with partner countries, donor nations, civil society, people living with HIV, faith-based organizations, the private sector, foundations and multilateral institutions to effectively mobilize, coordinate and efficiently utilize resources to expand high-impact strategies, saving more lives sooner.

>> Focus on women and girls to increase gender equality in HIV services.

>> End stigma and discrimination against people living with HIV and key populations, improving their access to, and uptake of, comprehensive HIV services.

>> Set benchmarks for outcomes and programmatic efficiencies through regularly assessed planning and reporting processes to ensure goals are being met.

These principles drive PEPFAR’s work and are the foundation for the road maps that comprise this blueprint.


Road Map for Saving Lives

This road map addresses the Secretary’s call in her November 8, 2011 speech to scale up combination HIV prevention and treatment interventions to save more lives. Specifically, the section outlines PEPFAR’s plan to:

  1. Work toward the elimination of new HIV infection among children by 2015 and keeping their mothers alive.

  2. Increase coverage of HIV treatment both to enhance HIV prevention.

  3. Increase the number of males who are circumcised for HIV prevention.

  4. Increase access to, and uptake of, HIV testing and counseling, condoms and other evidence based, appropriately-targeted prevention interventions.

Through its continued support for scale-up of combination prevention and treatment interventions in high-burden countries,  PEPFAR will help countries reduce new HIV infections and decrease AIDS-related mortality, while simultaneously increasing the capacity of countries to sustain and support these efforts over time. This support will, in turn, move more countries past the programmatic tipping point in their HIV epidemics—the point at which the annual increase in new patients on ART exceeds annual new HIV infections—and put them on the path toward achieving an AIDS-free generation


Road Map for Smart Investments


To achieve an AIDS-free generation, countries must target efforts where the virus is—reaching and supporting those populations at greatest risk and urgently needing services.  Accordingly, PEPFAR will work with countries to scale-up activities that have a strong evidence base to produce a population-level impact. We will not support interventions that fail to target the epidemic. Concurrently, we will work to realize efficiency gains to deliver greater results for our investment. We have vastly increased PEPFAR’s value for money by reducing the cost of antiretroviral drugs (ARVs), streamlining supply chains, and working with partner countries to increase their investments, and this work will remain a PEPFAR priority. We will also continue to lead efforts to strengthen the Global Fund.

For every dollar donated by the U.S., approximately $2.50 has been leveraged from donor governments, philanthropy and the private sector for the Global Fund.. This road map outlines how we will follow the epidemic, invest in evidence-based interventions, and continue to generate value for money in our fight against AIDS.


Specifically, this road map outlines PEPFAR’s

plan to:

1. Target HIV-associated tuberculosis (TB) and reduce co-morbidity and mortality.

2. Increase access to, and uptake of, HIV services by key populations.

3. Partner with people living with HIV to design, manage and implement HIV programs to ensure that they are responsive to, and respectful of, their needs.

4. Strengthen PEPFAR’s continued focus on women, girls and gender equality.

5. Reach orphans and vulnerable children (OVC) affected by AIDS, and support programs that help them develop to their full potential.

6. Strengthen programmatic commitment to and emphasis on reaching and supporting young people with HIV services.

7. Strengthen PEPFAR supply chains and business processes to increase the efficiency of ourinvestments.

8. Increase efficiencies through innovation and greater integration of services with other U.S., bilateral and multilateral global health investments.


Road Map for Shared Responsibility


As stated earlier, the goal of creating an AIDS-free generation is a shared responsibility with partner countries in a convening role. Neither the U.S. nor any other single entity can accomplish this goal alone. Rather, it requires a country to demonstrate political will and effective coordination of multiple partners that are providing financing and carrying out interventions both inside and outside of the health sector, and most importantly,  meaningfully involve those living with and affected by HIV in all aspects of the response.

Specifically, this road map outlines PEPFAR’s plan to:

1. Partner with countries in a joint move toward country-led, managed, and implemented responses.

2. Increase support for civil society as a partner in the global AIDS response.

3. Expand collaboration with multilateral and bilateral partners.

4. Increase private sector mobilization toward an AIDS-free generation.


Road Map for Driving Results with Science


Science has brought us to the point where we can actually call for an AIDS-free generation. And it is science that will underpin all our efforts to achieve this goal and save even more lives. To deliver the greatest response,  PEPFAR will continue to support programs guided by scientific evidence—we will go where the science takes us, translating science into

program impact.

Specifically, this road map outlines PEPFAR’s plan to:

1. Leverage greatest impact by continuing to invest in implementation science.

2. Support implementation research.

3. Evaluate the efficacy of optimized combination prevention.

4. Support innovative research to develop new technologies for prevention (e.g., microbicides, vaccines) and care (e.g., new treatments or treatment regimens).

5. Develop evidence-based approaches to reaching people early enough in their disease progression to help maintain a strong immune system, stave off opportunistic infections, particularly TB, and reduce new HIV infections.

6. Support the deployment of suitable technology for measurement of viral load, both through tiered laboratory networks and ‘point-of-care’ tests as they become available.

7. Assist countries in adopting breakthrough new technologies with proven impact, such as new, molecular-based TB tests that have dramatically reduced diagnosis and treatment time for people living with TB and HIV.





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Vision for the National HIV/AIDS Strategy
EXECUTIVE SUMMARY
http://aids.gov/federal-resources/national-hiv-aids-strategy/implementation-update-2012.pdf


“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.”
Reducing New HIV infections


Action Steps:
• Intensify HIV prevention efforts in communities where HIV is most heavily concentrated.
• Expand targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches.

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Office of State-2013

In July 2010, PresidentObama released theNational HIV/AIDS Strategy (the Strategy) with a simple, butinspiring 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.” 

The Strategy outlined three primary HIV health outcome goals: 1) reducing new HIV infections, 2) increasing access to care and optimizing health outcomes for people living with HIV, and 3) reducing HIV‐related health disparities.  To accomplish these goals, the President declared that we must undertake a more coordinated national response to the HIV epidemic.  And that’s what the key Federal agencies involved in the fight against AIDS set out to do – working with state, tribal and local governments, businesses, faith communities, philanthropy, the scientific and medical communities, educational institutions, people living with HIV, and others.    

It was and remains an ambitious undertaking, but one that we must continue to prioritize. As noted later in this report, recent national and jurisdictional data indicate we are making gains against HIV. We are making progress and we cannot afford to stop now. In fact, our efforts to implement the Strategy must continue to accelerate, concentrating investments in populations most affected by HIV and with the greatest HIV‐related health disparities, including gay and bisexual men, blacks, and Latinos.

Analyses conducted since the Strategy’s release show that there are significant gaps along the HIV care continuum—the sequential stages of care from being diagnosed to receiving optimal treatment—including that only 25 percent of people 

living with HIV in the United States have the virus under control. That is why this past July the President announced the establishment of the HIV Care Continuum Initiative to accelerate improvements in HIV prevention and care.  Recent scientific discoveries have greatly enhanced our understanding of how to prevent and treat HIV. For example, treatment is now recommended for all adults and adolescents living with HIV in the United States to reduce the long‐term consequences of HIV. Recent research also shows that an important benefit of earlier treatment is that it dramatically reduces the risk of HIV transmission to partners.  Furthermore, HIV testing technology is faster, and more accurate than ever before, and HIV medications are less toxic and easier to administer.   

In response to these compelling data, this report presents the first group of recommendations and action steps from the Federal HIV Care Continuum Working Group to help move our nation forward in meeting the goals of the Strategy by focusing on improving rates of diagnosis and care. The next stage of implementing the Strategy will be guided in largpart by the HIV Care Continuum Initiative, in concert with ongoing implementation of the Affordable Care Act, which will increase healthcare coverage for thousands of persons living with HIV and millions at risk for infection. 

In addition to new recommendations and actions for Federal agencies, this report provides persuasive examples of both local efforts and public‐private partnerships that are already using data effectively to improve testing, services and treatment along the care continuum.  By building on what we know works and implementing new ideas, we can accelerate progress toward the Strategy’s goals.  

We are at a transformative time. As the President said in his 2013 State of the Union Address, “realizing the promise of an AIDS‐free generation…is within our reach.” But we cannot rest as long as there are still too many Americans living with HIV who have not realized the benefits of treatment and others who are becoming infected every day.  With science continuing to provide the foundation for our efforts, a strong Federal commitment to support state and local partners, and ongoing community engagement and leadership from people living with HIV, we are moving collectively, 

aggressively forward.

State of Epidemic-2013

The State  of the Epidemic

How are we doing with regard to HIV prevention and care in the United States? It is important to begin by reviewing the most recent data and reflect on how they inform the challenges that lie ahead.   

The President has made implementing the Strategy a top priority, with the core values of the Strategy remaining just as relevant today as when it was announced. Resources have been re‐allocated to better align with the geographic regions and populations bearing the greatest burden of the epidemic. Collecting, analyzing, and responding to accurate data have been prioritized. Reporting has been standardized and simplified.  Our robust efforts to scale up science‐based interventions targeting communities most affected by HIV and have population‐level impact continue.  We have enhanced efforts to confront stigma and discrimination. And we continue to strengthen and grow partnerships across all levels of government and with private stakeholders and the community to support a collective response to the epidemic.  

Moreover, people living with HIV will continue to benefit from ongoing implementation of the Affordable Care Act.  

People living with HIV have higher rates of being uninsured, are more likely to face barriers in accessing medical care, and often experience higher rates of stigma and discrimination than other groups.  The health care law expands 

Medicaid, in states that choose to do so, for low‐ income people; strengthens and improves Medicare; and expands access to affordable private insurance options.  It also prohibits discrimination on the basis of HIV status while banning lifetime dollar limits and phasing out annual dollar limits on essential health benefits for most insurance plans. 

As we continue implementation of the Strategy and the Affordable Care Act, it is reasonable to ask: how will we benchmark progress?  Figure 1 presents the latest data on the Strategy’s indicators. Because they are from either 2010 or 2011, these data cannot be used to grade the success of the Strategy, which was released in July of 2010. Instead, the value of the information is that it provides the most recently available data that give an accurate assessment of the status of the epidemic in the United States, and show changes from baseline estimates that were used to set the Strategy’s targets. 

Overall, this update shows progress, with eight of the nine Strategy indicators showing improvements from baseline. On the other hand, one indicator remained essentially stable, and progress towards several of the targets has been slow, especially for those in which multiple years have elapsed between the baseline and follow‐up measure. To meet the targets of the Strategy, we must do better. Concerted and focused implementation efforts since the Strategy’s release reflect that commitment; details can be found in prior reports on AIDS.gov.

Hilary Clinton's Provoking Statement


Hilary Clinton's Provoking Statement
Now while the finish line is not yet in sight, we know we can get there, because now we know the route we need to take. It requires all of us to put a variety of scientifically proven prevention tools to work in concert with each other. Just as doctors talk about combination treatment – prescribing more than one drug at a time – we all must step up our use of combination prevention.


America’s combination prevention strategy focuses on a set of interventions that have been proven most effective – ending mother-to-child transmission, expanding voluntary medical male circumcision, and scaling up treatment for people living with HIV/AIDS. Now of course, interventions like these can’t be successful in isolation. They work best when combined with condoms, counseling and testing, and other effective prevention interventions. And they rely on strong systems and personnel, including trained community health workers. They depend on institutional and social changes like ending stigma; reducing discrimination against women and girls; stopping gender-based violence and exploitation, which continue to put women and girls at higher risk of HIV infection; and repealing laws that make people criminals simply because of their sexual orientation.

http://www.state.gov/secretary/rm/2011/11/176810.htm



• Educate all Americans about the threat of HIV and how to prevent it


Anticipated Results:
• By 2015, lower the annual number of new infections by 25% (from 56,300 to 42,225).
• Reduce the HIV transmission rate, which is a measure of annual transmissions in relation to the number of people living
with HIV, by 30% (from 5 persons infected per 100 people with HIV to 3.5 persons infected per 100 people with HIV).
• By 2015, increase from 79% to 90% the percentage of people living with HIV who know their serostatus (from 948,000 to
1,080,000 people).
Increasing Access to Care and Improving Health Outcomes for People Living with HIV


Action Steps:
• Establish a seamless system to immediately link people to continuous and coordinated quality care when they are
diagnosed with HIV.
• Take deliberate steps to increase the number and diversity of available providers of clinical care and related services for
people living with HIV.
• Support people living with HIV with co-occurring health conditions and those who have challenges meeting their basic
needs, such as housing.


Anticipated Results:
• By 2015, increase the proportion of newly diagnosed patients linked to clinical care within three months of their HIV
diagnosis from 65% to 85% (from 26,824 to 35,078 people).
• By 2015,increase the proportion of Ryan White HIV/AIDS Program clients who are in care (at least 2 visits for routine HIV
medical care in 12 months at least 3 months apart) from 73% to 80% (or 237,924 people in continuous care to 260,739
people in continuous care).
• By 2015, increase the number of Ryan White clients with permanent housing from 82% to 86% (from 434,000 to 455,800
people). (This serves as a measurable proxy of our efforts to expand access to HUD and other housing supports to all
needy people living with HIV).
Reducing HIV-Related Health Disparities and Health Inequities


Action Steps:
• Reduce HIV-related mortality in communities at high risk for HIV infection.
• Adopt community-level approaches to reduce HIV infection in high-risk communities.
• Reduce stigma and discrimination against people living with HIV.


Anticipated Results:
• By 2015, increase the proportion of HIV diagnosed gay and bisexual men with undetectable viral load by 20%.
• By 2015, increase the proportion of HIV diagnosed Black Americans with undetectable viral load by 20%.
• By 2015, increase the proportion of HIV diagnosed Latinos with undetectable viral load by 20%.
Achieving a More Coordinated National Response to the HIV Epidemic in the United States
• 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.

PREVENTION

Ð Get vaccinated against Human Papillomavirus (HPV).
Ð Say no to sex or delay sex until another time in your life.
Ð Talk with your doctor about the most effective contraception 
options for your lifestyle and needs. 
Ð Use your chosen contraceptive option correctly.
Ð Establish and be faithful in a long-term, mutually-monogamous relationship.
Ð Use condoms correctly and every time.
Ð Talk with your doctor about routine screening for early detection 
of HIV, chlamydia and other STIs.
Ð Use a buddy system when going out to prevent alcohol and sex 
related incidents.

Community Health

FY 2014 Funding

The Division of Community Health (DCH) manages three new awards that total nearly $94 million and support 93 grantees that include large and small cities and counties, tribal organizations, and national and community organizations. These awards support cross-cutting programs that prevent and control chronic diseases and improve community health:

View the full list of DCH community health investments for Fiscal Year 2014 here[PDF–157K].
Download the map[PDF-388K] for all Fiscal Year 2014 Awardees to learn more about DCH Investments.



HIV Surveillance Special Reports

HIV Surveillance Special Reports are based on data collected by CDC through special studies and surveys. They are not based on HARS data and they appear intermittently. Prior to number 6, the report was referred to as the HIV/AIDS Surveillance Special Report.