Preview of 2012: The Battles That Will Shape the Future of HIV
January 6, 2012
With all the achievements, as well as a few disappointments, of 2011 officially behind us, our attention now turns to 2012, which almost certainly will prove to be an historic year in the fight against HIV. Below, we preview some of the policy issues in 2012 that could turn the battle against HIV, for better or worse.
Affordable Care Act
In 2012, 10 new provisions of the Affordable Care Act are set to be implemented. The provisions take important steps toward preventing fraud and changing the way that the government pays for health care. However, the highlight of 2012 surely will be the Supreme Courts ruling on the constitutionality of the Affordable Care Act, with a focus on the individual mandate that requires all Americans to buy health insurance by 2014 or pay a penalty. The Court is expected to hear the case in March. The ruling is due by July 2012, and will be critical to determining the extent to which the ACA can be implemented in its original form. A second major highlight in 2012 will be work to develop the Essential Health Benefits (EHB) package. The EHB is one of the key provisions of ACA. It guarantees that plans provide adequate benefits to their enrollees benefits that will mirror the typical employer-sponsored plan.
The President will submit his Fiscal Year (FY) 2013 budget proposal to Congress no later than the first Monday of February. The Presidents FY 2013 proposal is expected to conform with the spending cap mandated by the Budget Control act. The FY 2012 budget cut $700 million from the Departments of Health and Human Services budget, though some notable domestic HIV/AIDS programs essentially were able to maintain their FY 2011 funding levels, including the Centers for Disease Control and Preventions HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis Prevention programs; the Minority AIDS Initiative; and the Ryan White HIV/AIDS Program.
In 2011, debts and deficits drove fiscal policy, as well as political rhetoric, and 2012 looks to be no different. Deficit reduction talks in 2012 will revolve around the Budget Control Act of 2011, the legislation that mandated Congress to develop a plan that would reduce the deficit by $1.2-$1.5 trillion over the next 10 years. Congress deadline for approving a plan is January 2, 2013. If Congress does not reach an agreement, $1.2 trillion will be cut automatically with 50% coming from defense programs and the other 50% coming from nondefense programs. Certain members of Congress already have called for defense programs to be exempted from the automatic cuts. Though AIDS United does not take a position on cuts to defense programs, any attempt to shift cuts from defense programs to programs that serve people living with HIV would be unacceptable and would be met with our vigorous opposition.
The Temporary Payroll Tax Cut Continuation Act of 2011 was signed by President Obama just before the Congressional recess. The extension gave Congress until February 29 to negotiate continuing a tax cut for social security from 6.2% to 4.2%, a tax cut that is supported by the President. Also included in the extension was a postponement of cuts to Medicare reimbursements for doctors. Medicare payments to physicians were scheduled to be cut by 27% this year. A congressional conference committee has been created to extend the payroll tax cut and to come up with a long term solution for Medicare reimbursements. The committee is expected to first meet the week of January 16.
Elections in 2012 will determine the makeup of the 113th Congress, as well as the occupier of the White House. The new Congress and the winner of the presidential election will be faced with reauthorizing the Ryan White Care Act in 2013, implementing the major reforms of the Affordable Care Act, continuing the implementation of the National HIV/AIDS Strategy, and determining funding appropriations for domestic HIV/AIDS programs under the mandates of the Budget Control Act and annual fiscal year budgets. Additionally, a number of biomedical HIV interventions are being developed, and will require the financial commitment and the vocal support of all our political leaders.
Deplorably, Congress included a ban on federal funding for syringe exchange programs (SEPs) in the final Fiscal Year 2012 appropriations omnibus. Despite the fact that SEPs have been incontrovertibly proven to reduce rates of HIV transmission in a way that is significantly cost-effective, the ban, which was originally instituted in the late 80s and overturned in 2009, was reinstated. In 2012, HIV advocates and organizations will and must work to hold Congress and the White House accountable for this reprehensible step backward in the fight against HIV.
The past couple years have seen a flurry of biomedical advances that have given many hope that science is finally starting to gain in the fight against HIV. In 2011, we saw encouraging results in trials that tested vaccines, pre-exposure prophylaxis (PrEP), and the efficacy of ARV treatment in preventing transmission among serodiscordant couples. In 2012, the Food and Drug Administration will consider an application from Gilead Sciences, that requests Truvada be labeled as an HIV PrEP in addition to its current label as an HIV treatment drug. PrEP is the use of HIV medications to prevent an HIV infection. Gileads request is based on findings from a worldwide study showing that PrEP containing the HIV drug Truvada, reduced the rate HIV incidence by 44 percent. Additionally, the Follow-On African Consortium for Tenofovir Studies (FACTS) Trial is conducting a study to investigate the effectiveness of a vaginal microbicide gel containing the HIV drug, tenofovir. The FACTS 001 study will test if a vaginal gel containing tenofovir is effective at preventing HIV and herpes virus 2 transmission among women when used immediately before and after sex. Results are expected in 2013.
In recent news, researchers testing HIV vaccines in monkeys have found their most successful vaccine, which used two different strains of adenovirus that normally causes colds, to be 80 percent effective at preventing infection. "As far as animal trials go, this is a solid step in trying to track down the [biological markers] of immunity," said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, which provided partial funding of the study.
National HIV/AIDS Strategy
In July of 2012, we will mark the end of the second year of the National HIV/AIDS Strategy (NHAS). The milestone will find us 2/5 of the way toward 2015 from when the Strategy was originally released in 2010. The Administration has sought to reach the goals of NHAS by collaborating and enhancing their partnership with state and local HIV authorities. NHAS has called for ambitious levels of reduction in new HIV incidence, increases in access to care and improved health outcomes for people living with HIV, and reduction in HIV-related health disparities. The Administration will be expected to show quantifiable progress that has been made toward these goals over the past two years. Reaching the goals of NHAS would be impossible without better access to healthcare for people living with HIV, therefore, the Supreme Courts ruling on the constitutionality of the Affordable Care Act will be pivotal to determining the success of NHAS over the next three years.
International AIDS Conference
For the first time in 20 years, the International AIDS Conference (IAC) will be held in the United States. Appropriately, the conference host will be Washington DC. The timing in an election year, as well as the location of IAC will create an extraordinary opportunity for HIV activists to call for presidential and Congressional candidates to take a position on the myriad legislation and policies that impact people living with HIV.
Ronald Johnson is vice president of policy and advocacy at AIDS United.
This article was provided by AIDS United. Visit AIDS United's website to find out more about their activities and publications.
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