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An Interview With Dr. David Holtgrave on the NHAS

June 8, 2012

Dr. David Holtgrave.

In last week's Update, we highlighted the recently-published paper, "Costs, Consequences and Feasibility of Strategies for Achieving the Goals of the National HIV/AIDS Strategy in the United States: A Closing Window for Success?" This week, we are pleased to bring you an interview with one of the lead authors of the paper, David R. Holtgrave, PhD, Chair of the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health.

AIDS United Policy Update: Is it still possible to achieve the goals of the National HIV/AIDS Strategy (NHAS) by 2015?

Dr. David Holtgrave: Yes, but we have to take action very quickly if we hope to do so.

AUPU: Is it realistic to expect that the investment necessary to achieve the goals of NHAS, which was intended to be spread out over a five-year period, can and will be made in the three-year window that remains before the 2015 deadline?

DH: It is true that the longer we wait to make the necessary investment, the more compressed the timeframe becomes. However, if we want to meet the 2015 NHAS goals, we have to make this investment in HIV prevention, care and housing programs; if we fail to do so, the goals of NHAS will not be met. The necessary resources could be new public sector investments (including new investments under the Affordable Care Act), highly selective redirections from other programs, or private sector investments; whatever the combination, the unmet needs have to be addressed to meet the goals of NHAS.

AUPU: Since the inception of NHAS, have you found that federal, state, and local governments, as well as non-governmental organizations, have changed the ways in which they allocate resources to reflect the goals of NHAS?


DH: I believe that at the local, state, and federal levels, as well as in civil society, people working on the HIV epidemic have tried very hard to align their efforts with NHAS. This can be seen in the recent resolutions passed by the President's Advisory Council on HIV/AIDS, in the metrics initiative being undertaken by the Department of Health and Human Services, by priorities expressed by individual federal agencies, by the Enhanced Comprehensive HIV Prevention Planning process, and in Baltimore (where I live) where the city's strategic plan for HIV exactly mirrors the structure of NHAS.

AUPU: Based on your research, what role can community and state-based organizations play in helping to achieve the goals of NHAS?

DH: NHAS itself, and our mathematical model, would suggest that it is very important to emphasize the delivery of HIV counseling and testing services, HIV care and treatment, HIV-related housing, prevention services for persons living with HIV, and the structural interventions necessary to make such services possible. These types of services can be prioritized at all levels, including community-based organizations and state- and local-level health departments.

AUPU: Over the past two years, has NHAS made a positive difference in the fight against HIV?

DH: Yes, absolutely. It has served to provide a vision for prioritizing some key service delivery areas; it has set some real, measurable, bold yet achievable goals; and it has emphasized coordination of service delivery. As the president said when he released the Strategy, "The question is not whether we know what to do, but whether we will do it." We do know what to do; unfortunately, we have not yet made the necessary level of investment to actually achieve the goals of NHAS.

AUPU: Based on your analysis, is it fair to say that we are behind schedule as far as reaching the goals of NHAS by 2015? If so, to what do you attribute our slow progress?

DH: Yes, sadly, I believe we are a bit behind schedule. However, there is an opportunity to catch up. With the right FY2013 investments, achieving the goals of NHAS is still possible. But that window is closing quickly. Without sufficient FY2013 investments in HIV prevention, care and housing, it is very hard to imagine how the goals of NHAS will be achieved in full. We can chart the course of the HIV epidemic in the U.S.; it is up to the nation to make the commitment and exhibit the will necessary to change the epidemic forever and in historic ways in the U.S.

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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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