#AIDSFREEGENERATION

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.

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

• HIV Infection, Risk, Prevention, and Testing Behaviors Among Heterosexuals at Increased Risk of HIV Infection

• Number 12:

• Behavioral and Clinical Characteristics of Persons Receiving Medical Care for HIV Infection, 2012